Physicians' Academy for Cardiovascular Education

Cardiac involvement and ongoing myocardial inflammation in recovered COVID-19 patients

Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

Literature - Puntmann VO, Carerj ML, Wieters I et al., - JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.3557

Introduction and methods

Case reports have suggested that COVID-19 affects the CV system in hospitalized patients [1-5]. However, much remains unknown about CV sequelae in unselected patients who recovered from COVID-19, including those who recovered at home, with no preexisting conditions, or had only mild or no symptoms. This prospective observational cohort study investigated the prevalence, extend, and type of CV sequelae in unselected patients who recently recovered from COVID-19 using serological markers of cardiac injury and cardiovascular magnetic resonance (CMR) imaging.

Participants were identified from the University Hospital Frankfurt COVID-19 Registry, which covers the area of the State of Hesse in Germany. Eligible participants were diagnosed with SARS-CoV-2 by RT-PCR on a swab test, had no respiratory symptoms after a minimum of 2 weeks from the original diagnosis, and had a negative result on a swab test at the end of the isolation period. A total of 100 patients who recently recovered from COVID-19 were included in this study, 53 were male and the median age was 49 (IQR 45-53) years. High sensitivity troponin T (hsTnT) and N-terminal pro-b-type natriuretic peptide were determined from blood samples and participants underwent CMR examination. Median time interval between COVID-19 diagnosis and CMR was 71 (IQR 64-92) days.

Comparisons were made with age-matched and sex-matched healthy controls (normotensive adults who were not taking cardiac medications, had normal cardiac volumes and function and had no evidence of scar; n=50). Comparisons were also made with risk factor-matched patients (matched for age, sex, hypertension, diabetes, smoking, known coronary artery disease, or comorbidities; n=57).

Main results


This prospective observational study evaluated the presence of myocardial injury in an unselected cohort of 100 patients who recently recovered from COVID-19 infection. CMR revealed cardiac involvement in 78% of patients and ongoing myocardial inflammation (defined as abnormal native T1 and T2 measures) in 60% of patients. Cardiac involvement and myocardial inflammation were independent of preexisting conditions, severity and overall course of the COVID-19 disease in the acute stage, and time from the original diagnosis. These findings highlight the need for further studies towards long-term CV consequences of COVID-19.


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Find this article online on JAMA Cardiol.

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