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Review
. 2023 Oct 18:18:e58.
doi: 10.15420/ecr.2023.02. eCollection 2023.

Cardiac Involvement Due to COVID-19: Insights from Imaging and Histopathology

Valentina O Puntmann  1 , Anastasia Shchendrygina  1 , Carlos Rodriguez Bolanos  1 , Mame Madjiguène Ka  1 , Silvia Valbuena  2 , Andreas Rolf  3 , Felicitas Escher  4 , Eike Nagel  1
Affiliations
Review

Cardiac Involvement Due to COVID-19: Insights from Imaging and Histopathology

Valentina O Puntmann et al. Eur Cardiol. .

Abstract

Lingering cardiac symptoms are increasingly recognised complications of severe acute respiratory syndrome coronavirus 2 infection, now referred to as post-acute cardiovascular sequelae of COVID-19 (PASC). In the acute phase, cardiac injury is driven by cytokine release and stems from ischaemic and thrombotic complications, resulting in myocardial necrosis. Patients with pre-existing cardiac conditions are particularly vulnerable. Myocarditis due to a direct viral infection is rare. Chronic symptoms relate to either worsening of pre-existing heart disease (PASC - cardiovascular disease) or delayed chronic inflammatory condition due to heterogenous immune dysregulation (PASC - cardiovascular syndrome), the latter affecting a broad segment of previously well people. Both PASC presentations are associated with increased cardiovascular risk, long-term disability and reduced quality of life. The recognition and management of PASC in clinical settings remains a considerable challenge. Sensitive diagnostic methods are needed to detect subtler inflammatory changes that underlie the persistent symptoms in PASC - cardiovascular syndrome, alongside considerable clinical experience in inflammatory cardiac conditions.

Keywords: COVID-19; PASC; cardiovascular magnetic resonance; myocardial injury; myocarditis; post-acute sequelae of COVID-19.

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Conflict of interest statement

Disclosure: VOP and EN have received speaker fees from Bayer and Siemens, and scientific grants from Bayer. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Spectrum of Pathophysiology of Cardiovascular Involvement Due to COVID-19
Figure 2:
Figure 2:. Acute COVID-19 Illness with Cardiac Decompensation
Figure 3:
Figure 3:. Post-acute Cardiovascular Sequelae of COVID-19 – Cardiovascular Disease
Figure 4:
Figure 4:. Myocardial Involvement in Post-acute Cardiovascular Sequelae of COVID-19 – Cardiovascular Syndrome
Figure 5:
Figure 5:. Chronic Inflammation, Moderate Pericardial Effusion with Haemodynamic Compromise in PASC-CVS
See this image and copyright information in PMC

References

    1. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21:133–46. doi: 10.1038/s41579-022-00846-2. - DOI - PMC - PubMed
    1. Bowe B, Xie Y, Al-Aly Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med. 2022;28:2398–405. doi: 10.1038/s41591-022-02051-3. - DOI - PMC - PubMed
    1. Writing Committee; Gluckman TJ, Bhave NM et al. 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;79:1717–56. doi: 10.1016/j.jacc.2022.02.003. - DOI - PMC - PubMed
    1. Hendren NS, Drazner MH, Bozkurt B, Cooper LT. Description and proposed management of the acute COVID-19 cardiovascular syndrome. Circulation. 2020;141:1903–14. doi: 10.1161/CIRCULATIONAHA.120.047349. - DOI - PMC - PubMed
    1. Puntmann VO, Martin S, Shchendrygina A et al. Long-term cardiac pathology in individuals with mild initial COVID-19 illness. Nat Med. 2022;28:2117–23. doi: 10.1038/s41591-022-02000-0. - DOI - PMC - PubMed

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