Covid-19 and the heart: two new studies offer ideas

The disease caused by the new coronavirus can damage other organs of the body, including the heart, and now two separate studies, published in the journal JAMA Cardiology on Monday, provide more information on how Covid-19 can have a prolonged impact on heart health in those who have recovered from illness and may have caused heart infection in those who died.

“We have understood for a few months that Covid-19 is not just a respiratory infection but a multi-system infection,” said cardiologist Dr. Nieca Goldberg, medical director of the NYU Women’s Heart Program and senior advisor for health strategy. Women’s. at NYU Langone Health in New York, which was not involved in any of the studies.

“There is an acute inflammatory response, increased blood clotting, and cardiac involvement. And the cardiac involvement may be due to direct involvement of the heart muscle by the infection and its inflammatory response. It could be due to the formation of blood clots, which cause an obstruction of the arteries, “Goldberg said.

“Sometimes people have very fast heart rates that can, over time, weaken the heart muscle, reduce the function of the heart muscle. So there are several ways during this infection that can affect the heart.”

Inflammation of the heart

One of the JAMA Cardiology studies found that among 100 adults who recently recovered from Covid, 78% showed some form of cardiac involvement on MRIs and 60% had ongoing inflammation in the heart.
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The study included patients aged 45 to 53 who were from the Register of the Frankfurt University Hospital Covid-19 in Germany. They were recruited for the study between April and June. Most of the patients, 67, recovered at home, and the severity of their disease varied from being asymptomatic to having moderate symptoms.

The researchers used cardiac magnetic resonance imaging, blood tests, and biopsy of heart tissue. Those data were compared with a group of 50 healthy volunteers and 57 volunteers with some underlying health conditions or risk factors.

MRI data revealed that people infected with coronavirus had some form of cardiac involvement, regardless of pre-existing conditions, the severity or course of their infection, the time since their original diagnosis, or the presence of specific heart-related symptoms.

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The most common heart-related abnormality in Covid-19 patients was inflammation of the myocardium or abnormal inflammation of the heart muscle, which can weaken it.

This type of inflammation, also called myocarditis, is usually caused by a viral infection, Goldberg said, adding that the results of this study were not surprising.

“What they say in this study is that myocardial or cardiac involvement can be identified by magnetic resonance imaging,” said Goldberg.

The study has some limitations. More research is needed to determine if similar findings would emerge among a larger group of patients, those under the age of 18 and those currently struggling with coronavirus infection rather than simply recovering from it.

“These findings indicate the need for continued investigation of the long-term cardiovascular consequences of COVID-19,” the researchers wrote.

‘This infection does not follow a path’

In the other JAMA Cardiology study, an autopsy analysis found that the coronavirus could be identified in the heart tissue of the Covid-19 patients who died.
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The study included data from 39 autopsy cases from Germany between April 8-18. The patients, ages 78 to 89, tested positive for Covid-19 and the researchers analyzed the heart tissue from their autopsies.

The researchers found that 16 of the patients had viruses in the heart tissue, but showed no signs of unusual sudden inflammation in the heart or myocarditis. It is not clear what this means, the researchers said.

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The sample of autopsy cases was small and “the advanced age of the patients may have influenced the results,” the researchers wrote. More research is needed on whether similar findings would emerge among a younger group of patients.

“I think both studies are important,” said Goldberg.

“One more or less shows that MRI can help diagnose myocardial injury that occurs due to Covid and was confirmed on biopsy,” he said. “The autopsy study showed us something else that is interesting: that you can have a viral presence but not the acute inflammatory process. Therefore, this infection does not follow a path.”

‘An increasingly complex puzzle’

Both studies “add to an increasingly complex puzzle” when it comes to the new coronavirus called SARS-CoV-2, Dr. Dave Montgomery, founding cardiologist at the PREvent Clinic in Sandy Springs, Georgia, said in an email Tuesday. electronic.

Taken together, studies support that SARS-CoV-2 does not have to cause clinical myocarditis to find the virus in large numbers and the inflammatory response in myocardial tissue. In other words, one may have mild or mild cardiac symptoms. really cause harm, “said Montgomery, who was not involved in the studies.

“Viruses generally have a way of reaching organs that are quite far from the original site of infection. SARS-CoV-2 is no different in this regard,” he said. “What is different is that this virus seems to preferentially affect heart cells and the surrounding cells. These studies suggest that the heart may become infected without clear signs. Personally, in my practice, we have seen similar signs of inflammation, including pericardial effusions, “or fluid around the sac of the heart.

Dr. Clyde Yancy of Northwestern University Feinberg School of Medicine and Dr. Gregg Fonarow of University of California, Los Angeles, co-authored an editorial that accompanied the two new studies in the journal JAMA Cardiology on Monday.

“We see the plot worsen and we are inclined to raise a new and very apparent concern that COVID-19-related cardiomyopathy and heart failure may potentially evolve as the natural history of this infection becomes clear,” wrote Yancy and Fonarow in the editorial.

“We do not want to generate additional anxiety, but rather to incite other researchers to carefully examine existing data and collect new data in other populations to confirm or refute these findings,” they wrote.