Assessment of Adult Patients with Long COVID Manifestations Suspected as Cardiovascular: A Single-Center Experience

Abstract

Background: Persistent symptoms affect a subset of coronavirus disease 2019 (COVID-19) survivors. Some of these may be cardiovascular (CV)-related. Objective: To assess the burden of objective CV morbidity among, and to explore the short-term course experienced by, COVID-19 patients with post-infectious symptomatology suspected as CV. Methods: This was a single-center, retrospective analysis of consecutive adult patients with new-onset symptoms believed to be CV following recovery from COVID-19, who had been assessed at a dedicated 'Cardio'-COVID clinic between June 2020 and June 2021. All participants were followed for 1 year for symptomatic course and the occurrence of new CV diagnoses and major adverse cardiovascular events (MACE). Results: A total of 96 patients (median age 54 (IQR, 44-64) years, 52 (54%) females) were included in the final analysis. Initial visits occurred within a median of 142 days after the diagnosis of acute COVID. Nearly all (99%) patients experienced a symptomatic acute illness, which was graded as severe in 26 (27%) cases according to the National Institutes of Health (NIH) criteria. Long-COVID symptoms included mainly dyspnea and fatigue. While the initial work-up was mostly normal, 45% of the 11 cardiac magnetic resonance studies performed revealed pathologies. New CV diagnoses were made in nine (9%) patients and mainly included myocarditis that later resolved. An abnormal spirometry was the only variable associated with these. No MACE were recorded. Fifty-two (54%) participants felt that their symptoms improved. No association was found between CV morbidity and symptomatic course. Conclusions: In our experience, long-COVID symptoms of presumed CV origin signified actual CV disease in a minority of patients who, irrespective of the final diagnosis, faced a fair 1-year prognosis.

Keywords: cardiovascular complications; long COVID; prognosis.

Figure 1

Study flow chart. CCT = cardiac computed tomography; CMR = cardiac magnetic resonance; COVID = coronavirus disease; CPET = cardiopulmonary exercise test; CV = cardiovascular; ECG = electrocardiogram; H&P = history and physical; HRCT = high-resolution CT; MACE = major adverse cardiovascular events; PCR = polymerase chain reaction; PFT = pulmonary function test; TTE = transthoracic echocardiogram.

Figure 2

Presentation and objective findings demonstrated in Long-COVID Patients with suspected cardiovascular symptomatology. Among long-COVID outpatients assessed at a dedicated ‘Cardio’-COVID clinic due to suspected cardiovascular symptomatology, the leading symptoms at the initial visit were mainly non-specific, such as dyspnea and fatigue. Electrocardiographic aberrations were the most common objective findings and mainly included non-specific ST-T changes. COVID = coronavirus disease; CV = cardiovascular; LV = left ventricular; PHTN = pulmonary hypertension; RV = right ventricular; TR = tricuspid regurgitation.

Figure 3

Diagnostic tests performed on the study cohort. While basic work-up proved negative in most patients examined for presumed cardiovascular sequelae, more advanced tests revealed pathologic findings at a higher frequency. Notably, most chest CT studies displayed anomalies. CPET = cardiopulmonary exercise test; CT = computed tomography; MR = magnetic resonance.

Figure 4

One-year trends of long-COVID symptomatology believed to be cardiovascular. At 1-year follow-up, most patients felt their symptoms to improve compared to the initial visit. No major difference was noted between those who were diagnosed with new, potentially COVID-related cardiovascular conditions and those who were not. COVID = coronavirus disease; CV = cardiovascular.