Cardiovascular symptom phenotypes of post-acute sequelae of SARS-CoV-2

Abstract

Background: Acute COVID-19 infection has been shown to have significant effects on the cardiovascular system. Post-acute sequelae of SARS-CoV-2 (PASC) are being identified in patients; however, the cardiovascular effects are yet to be well-defined. The Post-COVID Cardiology Clinic at Washington University evaluates and treats patients with ongoing cardiovascular PASC.

Objectives: This investigation aims to describe the phenotypes of cardiovascular symptoms of PASC in patients presenting to the Post-COVID Cardiology Clinic, including their demographics, symptoms, and the clinical phenotypes observed.

Methods: This was a retrospective analysis of symptoms, clinical findings, and test results from the first 100 consecutive adult patients who presented to the Post-COVID Cardiology Clinic at Washington University in St. Louis, between September 2020 to May 2021 with cardiovascular symptoms following COVID-19 infection.

Results: The population (n = 100) had a mean age of 46.3 years and was 81% female. Most patients had mild acute illness, with only 23% of patients requiring hospitalization during acute COVID-19 infection. The most commonly reported PASC symptoms were chest pain (66%), palpitations (59%), and dyspnea on exertion (56%). Of those presenting with these symptoms, 74/98 patients (75.5%) were found to have a significant blood pressure elevation, considerable sinus tachycardia burden, reduced global longitudinal strain, increased indexed left-ventricular end-diastolic volume (LVEDVi) by echocardiogram, and/or cMRI findings consistent with possible active or healing myocarditis.

Conclusions: Our findings highlight clinical phenotypes of the cardiovascular manifestations of PASC. Further studies are needed to evaluate the pathophysiology, treatment options and long-term outcomes for these patients.

Keywords: COVID-19; Cardiac magnetic resonance imaging; Post-acute sequelae of SARS-CoV-2; Sinus tachycardia.

Fig. 1

Time from initial COVID-19 infection to presentation with PASC. Fig. 1 is a histogram illustrating the distribution of time in days from COVID-19 diagnosis to initial cardiology office visit. Patients had a significant lag between COVID diagnosis and initial office visit, during which PASC cardiovascular symptoms were still ongoing. Ninety-nine days is the median duration.

Fig. 2

PASC cardiovascular symptoms. Fig. 2 represents the distribution of cardiovascular PASC symptoms among the cohort of 100 consecutive patients presenting to the clinic. A majority of patients reported chest pain and/or palpitations. The percentage at the end of each bar represents the percentage of patients experiencing each of these symptoms.

Fig. 3

Systolic and diastolic blood pressure distribution. Fig. 3 demonstrates the blood pressure increase between baseline and initial cardiology office visits for systolic and diastolic pressures in A and B, respectively. Lines highlight the median values.

Supplemental Fig. 2

Heart rate and weight distribution. Fig. 2 demonstrates the heart rate (A) and weight increase (B) between baseline and initial cardiology office visits.