1356892 - Persistent long-term myocardial involvement in post-COVID

Patients after post-COVID suffer from diverse persistent symptoms including cardiac manifestation. Aim of this study was to analyze long-term cardiac involvement in patients suffering at least three months from post-COVID symptoms.

Methods:

We prospectively examined the clinical and imaging data of 94 patients at a median of 99 days (IQR 64-110 days) post COVID-19 infection from January 2021 to March 2022. Left ventricular performance was evaluated by cardiovascular magnetic resonance imaging in all patients after post COVID compared to a healthy control group (n=100). A follow-up scan was conducted in case of a positive CMR meeting the criteria for myocarditis after a median of 87 days (IQR 82-105) after initial CMR. Major adverse clinical events and cardiovascular death were determined for each patient at a median of 269 days (IQR 146-205days) after initial presentation.

Results: A total of 194 patients were included into the study. The majority of post-COVID patients had mild clinical course after initial infection. There was no significant difference between post-COVID patients and the group of healthy controls regarding systolic leftventricular ejection fraction (63.6% vs. 63.2%, p=0.85). 

After multivariable regression analysis we observed a significant difference in myocardial strain parameters between both groups: peak radial strain (GRS) -2.9% (-5.4; -0.4), p=0.025, peak circumferential strain (GCS) 1.2% (0.4; 2.0), p=0.003, systolic circumferential strain rate 0.08/s (0.01; 0.15), p=0.02; systolic longitudinal strain rate 0.08/s (0.01; 0.15), p=0.035.

Conclusion:

Patients with post COVID show long-term myocardial mechanical changes in CMR, while traditional leftventricular functional parameters are normal. Systolic strain pattern is altered in these patients and might be one explanation for prolonging symptoms after post-COVID in patients with long-term symptoms. These findings underline the need for further investigation after prolonging post-COVID symptoms to detect long-term myocardial changes.