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Six months post-infection, the hearts of patients who had mild disease appear similar on cardiac MRI scans to the hearts of patients who were never infected.
Lasting heart damage is unlikely in patients who suffer from mild COVID-19 infection, according to new research, indicating there is little need to screen the hearts of these patients.
In a study published May 8 in JACC Cardiovascular Imaging, a team of investigators from University College London (UCL) showed, based on an analysis of healthcare workers who became infected with the virus while caring for patients, that people who are either asymptomatic or who develop mild symptoms do not suffer the same cardiovascular problems as those with severe disease, such as blood clots or heart inflammation.
“Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals six months post-mild severe acute respiratory syndrome coronavirus 2 infection,” said the team led by Thomas Treibel, MBBS, Ph.D., from the UCL Institute of Cardiovascular Science and Barts Health NHS Trust.
There has been a great deal of research over the past year into how the virus impacts the hearts of patients who suffer severe disease, but, to date, there has been little work into whether patients with mild cases will experience the same lingering, potentially life-long, problems. These findings, the team said, should assuage the cardiovascular concerns of the overwhelming majority of patients who experience mild COVID-19 cases.
“Disentangling the impact COVID-19 has on the heart has been a challenge,” Triebel said. “But, we’re now at the stage of the pandemic where we can really start to get a grip on the longer-term implications COVID-19 has on the health of our heart and blood vessels.”
For their study, the team drew from the pool of healthcare providers who worked most closely with patients who were COVID-19-positive. They selected 149 individuals with mild symptoms from the COVIDsortium, a study from three London hospitals where healthcare workers provided weekly blood, saliva, and nasal swab samples for 16 weeks. Participants had an average age of 37 and 58 percent of the group were female.
The team conducted cardiac MRI exams on 74 healthcare workers six months after their mild infection, focusing on heart structure and function. They compared their findings to scans from 75 healthy age, sex, and ethnicity matched controls who were never infected with the virus.
Based on their analysis, the team determined that between the group with previous mild COVID-19 and those who never contracted the virus, there were no differences in cardiac structure (left ventricular volumes, mass, or atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro-B-type natriuretic peptide).
Some small abnormalities were picked up on MRI, but they were not identified more often in patients who had been infected than in those who were not. The changes, the team said, could have been caused by multiple non-COVID-related factors.
By examining a patient population with such close contact with the virus, Treibel said, the team is able to offer some reassurance as the pandemic continues on worldwide.
“We’ve been able to capitalize on our incredible frontline staff who’ve been exposed to the virus this past year, and we’re pleased to show that the majority of people who’ve had COVID-19 seem to not be at increased risk of developing future heart implications,” he said. “We now need to focus our attention on the long-term impact the virus has in those who’ve been hit hardest by the disease.”
Treibel’s colleague Sonya Babu-Narayan, MBBS, associate medical director at the British Heart Foundation (BHF) and consultant cardiologist, agreed these findings are a positive step in the continued fight against the pandemic – and that more work is coming.
“Throughout the pandemic, BHF researchers have made progress investigating the short and long-term effects of COVID-19 on the heart and circulatory system,” she said. “There’s still a lot more work to be done, but for not it seems the good news is that mild COVID-19 illness does not appear to be linked to lasting heart damage.”
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