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Two new studies from Germany paint a sobering picture of the cost Covid-19 has on the heart, raising the specter of long-term damage after people recover, even if their disease was not severe enough to require hospitalization.
One study examined the cardiac MRIs of 100 people who had recovered from Covid-19 and compared them to images of the hearts of 100 people who were similar but not infected with the virus. Their average age was 49 years and two thirds of the patients had recovered at home. More than two months later, infected patients were more likely to have troublesome cardiac signs than people in the control group: 78 patients showed structural changes in their hearts, 76 had evidence of a biomarker indicating cardiac injury typically found after a heart attack, and 60 had signs of inflammation.
These were relatively young, healthy patients who got sick in the spring, Valentina Puntmann, who led the MRI study, said in an interview. Many of them had just returned from skiing vacations. None of them thought they had something wrong in their hearts.
“The fact that 78% of ‘recovered’ [patients] having evidence of continued cardiac involvement means that the heart is involved in most patients, even if Covid-19 disease does not scream with classic cardiac symptoms, such as anginal chest pain, “she told STAT. She is a cardiologist at University Hospital Frankfurt. “In my opinion, the relatively clear onset of Covid-19 disease provides an opportunity to take proactive measures and seek cardiac involvement early.”
The other study, which looked at autopsy results on 39 people who died early in the pandemic and whose average age was 85, found high levels of the virus in the hearts of 24 patients.
“We see signs of viral replication in those who are heavily infected,” Dirk Westermann, a cardiologist at the Cardiovascular and Vascular Center at the University of Hamburg, said in an interview. “We do not yet know the long-term consequences of changes in gene expression. I know from other diseases that it’s obviously not good to have that higher level of inflammation. “
Taken together, the two studies, published Monday in JAMA Cardiology, suggest that in many patients, Covid-19 could presage heart failure, a chronic and progressive condition in which the heart’s ability to pump blood throughout the body decreases. It is too early to say whether the damage in patients recovering from Covid-19 is transient or permanent, but cardiologists are concerned.
“These are two studies that suggest that being infected with Covid-19 carries a high probability of having some involvement of the heart. If you don’t answer questions, [they] they raise important questions about what the cardiac consequences are, ”said Matthew Tomey, a cardiologist and assistant professor of medicine at the Icahn School of Medicine at the Mount Sinai Health System in New York. Did not participate in any of the studies.
“The question now is how long these changes persist,” he added. “Will they become chronic effects on the heart or are they, we hope, temporary effects on heart function that will gradually improve over time?”
Since the pandemic began, people with underlying cardiovascular problems, such as high blood pressure, coronary artery disease, or heart failure, have been known to be at increased risk of infection and death. The connection between Covid-19 and blood clots emerged later, after doctors began connecting the lung aneurysms, strokes, and heart attacks they were seeing with the virus.
Heart problems in recovering patients could belong to a pattern of persistent symptoms. Tomey sees signs of weakness in patients who had Covid-19 in March or April, when the disease was emerging in New York.
“Patients come to my office saying, ‘Hi, I’m a 31-year-old man who used to run and was completely limitless in my exercise, and now I get palpitations when crossing the street. Or I gasp going up to my second floor apartment, ” he said. “People are exquisitely tuned to their own exercise capacity, so I take it very seriously. Our challenge is to understand why. “
Marc Pfeffer, a cardiologist at Brigham and Women’s Hospital in Boston, called the autopsy and MRI studies a sobering warning. He was also not involved. You are concerned that relatively young people lose their heart health reserves, which generally decline with age and may set the stage for heart failure.
“We knew that this virus, SARS-CoV-2, does not spare the heart,” he said. “We are going to make many people go through the acute phase [but] I think there will be a long-term price to pay. “
In an editorial about the two studies, Clyde Yancy, a cardiologist at Northwestern Feinberg School of Medicine, and Gregg Fonarow, a cardiologist at UCLA’s Geffen School of Medicine, pushed for more research.
“If this high risk rate is confirmed, … then the COVID-19 crisis will not decrease, but will shift to a new de novo incidence of heart failure and other chronic cardiovascular complications,” they wrote. “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.”
When asked if something can now be done for patients, Tomey of Mount Sinai said, “I would love to have the answer to that question.”
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