1/4 of all cases? Severe cases, moderate, mild? Does this include asymptomatic?
Scans show cardiovascular impact lingers after the acute phase of viral infection and into recovery.
www.diagnosticimaging.com
MRI scans reveal that heart damage caused by COVID-19 remains present in 78 percent of patients who test positive for -- and recover from -- the virus, a new study has revealed.
In an article published July 27 in
JAMA Cardiology, investigators from Germany revealed that
the majority of patients who recover from the viral infection sustain cardiovascular damage regardless of any pre-existing conditions or their severity of disease.
“The results of our study provide important insights into the prevalence of cardiovascular involvement in the early convalescent stage,” wrote the team led by Valentina Puntmann, M.D., Ph.D., from the Institute for Experimental and Translational Cardiovascular Imaging at the University Hospital Frankfurt.
“Our findings demonstrate that participants with a relative paucity of pre-existing cardiovascular condition and with mostly home-based recovery had frequent cardiac inflammatory involvement, which was similar to the hospitalized sub-group with regards to severity and extent.”
In addition, the study analysis revealed that
the cardiovascular damage lingers even after the acute phase of the disease has passed and patients have begun their recovery. T
he team identified the presence of ongoing inflammation in the heart muscle and the heart lining in most patients, pointing to two potentially dangerous heart conditions – myocarditis and pericarditis.
Consequently, they said, there is a need for more research to determine the full extent of the long-term impacts of COVID-19 on the heart.
To investigate how the virus affects the heart, Puntmann’s team evaluated 3T MRI scans from an unselected cohort of 100 patients who had recently recovered from COVID-19. To their knowledge, this was the first such study. Most patients (53 percent) were male, the average age was 46, and the majority (67 percent) recovered at home.
The severity of their disease course varied from asymptomic to severe enough to require hospitalization. Pre-existing conditions present among all patients included hypertension, diabetes, previously identified coronary artery disease, asthma, and chronic obstructive pulmonary disease. No patient had prior heart failure or cardiomyopathy...
...
Thirty-two percent of patients experienced myocardial late gadolinium enhancement, and 22 percent saw pericardial enhancement. ..
...
Even with these limitations, though, the results from this study are informative, said Clyde Yancey, M.D., chief of cardiology at Northwestern University Feinberg School of Medicine in an accompanying
editorial.
Not only do they point to the presence of residual left ventricular dysfunction and sustained inflammation, but they also highlight other important clinical patho-physiologies, such as clinical syndromes consistent with acute myocarditis, immunologic responses, and microvascular clot formation.
“When added to the postmortem pathological findings [from other studies,] we see that plot thickening, and we are inclined to raise a new and very evident concern that cardiomyopathy and heart failure related to COVID-19 may potentially evolve as the natural history of this infection becomes clearer,” said Yancey, who is also the deputy editor of
JAMA Cardiology. “We wish not to generate additional anxiety, but rather to incite other investigators to carefully examine existing and prospectively collect new data in other populations to confirm or refute these findings.”
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Most other studies showing similar results involved hospitalized patients. This study reveals that severity of disease did not seem to matter all that much. This and other reports raised alarm bells. Some reports have claimed that ten B1G athletes were found to have similar conditions. A former Florida St BB center in Europe recently died after "recovering" from COVID-19. I haven't seen any autopsy results on him, but I imagine similar pathologies are high on the list of differentials.
www.ncbi.nlm.nih.gov
It was recognized early during the outbreak of COVID-19 that greater than 20% of patients with COVID-19 had elevations in cardiac troponin and other manifestations of cardiac injury, including impaired left ventricular ejection fraction and an elevation in type-B-natriuretic peptide [
11]. The clinical aspects of these manifestations have been extensively reviewed elsewhere [
44,
45], but importantly, the manifestation of cardiovascular disease is a marker of a poor prognosis in COVID-19
Dean Winslow, an infectious-disease doctor at Stanford University, said research has shown as many as 20 percent of people who recover from covid-19 show cardiac abnormalities. ..
... “It’s turned out, now that we’re getting more long-term data, the virus also affects the heart,” Schneider said. “And perhaps in a very serious way.” ..
... Jonathan Kim, a sports cardiologist at Emory University, called a
recent study out of Germany published in the Journal of the American Medical Association particularly concerning. Researchers gave 100 patients who had recovered from covid-19, two-thirds of whom had suffered mild or no symptoms, cardiac MRI exams. The tests showed 78 percent had some kind of cardiac abnormality, and 60 percent showed inflammation consistent with myocarditis. ...
...
The study was composed of middle-aged people, and Emery said he would expect athletes as a group to fare better. But the results — that people with mild symptoms could suffer heart complications as a result of covid-19 — still startled him and his colleagues.
The findings were bad news for everyone in a general way and scary news for athletes in a specific way. An infection of the heart can cause myocarditis, an inflammation of the heart muscle. Myocarditis can lead to arrhythmia, cardiac arrest and death, especially in a person who doesn’t know they have it and performs rigorous exercise.
But the biggest cause for concern for cardiologists is the notion that covid-19 could lead to an increase in a condition that, in rare instances, leads to sudden death. While cases will be scarce, doctors said, the consequences demand alarm.
“The problem with the heart is if you’re wrong, you’ll end up ... dead,” Schneider said. “That’s what is so scary about the heart. A misjudgment can be fatal. That’s why it’s going to have a huge impact on sports.
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So the 1/4 is the number I heard from a cardiologist in a report (I forget what outlet I heard it on). Hear we have another saying 20%.
The more important takeaway is that cardiac injury following COVID-19 appears to be fairly common, even in nonhospitalized patients. Case reports are emerging that athletes at all levels of sport are affected. The evidence for even mild COVID-19 disease causing complications of the heart lingering after "recovery" is growing. Evidence had already mounted that these and similar heart issues have been a major driver of severe disease and death in those sick enough to be hospitalized. Now the new evidence raises concern levels, especially for athletes, who put a lot of demand on their hearts already.
There are still a lot of unanswered questions that are provoking more studies. More information will come out in time.
www.cnn.com
