Covid-19 infections leave an impact on the heart,
raising concerns about lasting damage
By
ELIZABETH COONEY @cooney_lizJULY 27, 2020Reprints
Two new
studies from Germany paint a sobering picture of the toll that Covid-19 takes
on the heart, raising the specter of long-term damage after people recover,
even if their illness was not severe enough to require hospitalization.
One study
examined the cardiac MRIs of 100 people who had recovered from Covid-19 and
compared them to heart images from 100 people who were similar but not infected
with the virus. Their average age was 49 and two-thirds of the patients had
recovered at home. More than two months later, infected patients were more
likely to have troubling cardiac signs than people in the control group: 78
patients showed structural changes to their hearts, 76 had evidence of a
biomarker signaling cardiac injury typically found after a heart attack, and 60
had signs of inflammation.
These were
relatively young, healthy patients who fell ill in the spring, Valentina
Puntmann, who led the MRI study, pointed out in an interview. Many of them had
just returned from ski vacations. None of them thought they had anything wrong
with their hearts.
“The fact
that 78% of ‘recovered’ [patients] had evidence of ongoing heart involvement
means that the heart is involved in a majority of patients, even if Covid-19
illness does not scream out with the classical heart symptoms, such as anginal
chest pain,” she told STAT. She is a cardiologist at University Hospital
Frankfurt. “In my view, the relatively clear onset of Covid-19 illness provides
an opportunity to take proactive action and to look for heart involvement
early.”
The other
study, which analyzed autopsy results from 39 people who died early in the
pandemic and whose average age was 85, found high levels of the virus in the
hearts of 24 patients.
“We see
signs of viral replication in those that are heavily infected,” Dirk
Westermann, a cardiologist at the University Heart and Vascular Centre in
Hamburg, said in an interview. “We don’t know the long-term consequences of the
changes in gene expression yet. I know from other diseases that it’s obviously
not good to have that increased level of inflammation.”
Taken
together, the two studies, published Monday in JAMA Cardiology, suggest that in
many patients, Covid-19 could presage heart failure, a chronic, progressive
condition in which the heart’s ability to pump blood throughout the body
declines. It is too soon to say if the damage in patients recovering from Covid-19
is transient or permanent, but cardiologists are worried.
“These are
two studies that both suggest that being infected with Covid-19 carries a high
likelihood of having some involvement of the heart. If not answering questions,
[they] prompt important questions about what the cardiac aftermath is,” said
Matthew Tomey, a cardiologist and assistant professor of medicine at the Icahn
School of Medicine at Mount Sinai Health System in New York. He was not
involved in either study.
“The
question now is how long these changes persist,” he added. “Are these going to
become chronic effects upon the heart or are these — we hope — temporary effects on cardiac function that
will gradually improve over time?”
Since the
pandemic began, people with underlying cardiovascular problems such as high
blood pressure, coronary artery disease, or heart failure have been known to be
at higher risk for infection and death. The connection between Covid-19 and
blood clots emerged later, after doctors began connecting the pulmonary
embolisms, strokes, and heart attacks they were seeing to the virus.
Cardiac
problems in recovering patients could belong to a pattern of lingering
symptoms. Tomey sees signs of weakness in patients who had Covid-19 in March or
April, when the disease was surging in New York.
“Patients
come to my office saying, ‘Hey, I’m a 31-year-old who used to run and be
completely unlimited in my exercise, and now I get palpitations walking across
the street. Or I get out of breath climbing up to my second-floor apartment,’”
he said. “Individuals are exquisitely tuned in to their own capacity for
exercise, so I take that very seriously. Our challenge is to understand the
why.”
Marc
Pfeffer, a cardiologist at Brigham and Women’s Hospital in Boston, called both
the autopsy and MRI studies a sobering warning. He was not involved in either.
He’s concerned about relatively young people losing their cardiac health
reserves, which typically decrease with age and can set the stage for heart
failure.
“We knew
that this virus, SARS-CoV-2, doesn’t spare the heart,” he said. “We’re going to
get a lot of people through the acute phase [but] I think there’s going to be a
long-term price to pay.”
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In an
editorial about the two studies, Clyde Yancy, a cardiologist at Northwestern’s
Feinberg School of Medicine, and Gregg Fonarow, a cardiologist at UCLA’s Geffen
School of Medicine, pushed for more research into the problem.
“If this
high rate of risk is confirmed, … then the crisis of COVID-19 will not abate
but will instead shift to a new de novo incidence of heart failure and other
chronic cardiovascular complications,” they wrote. “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.”
Asked if
there is something that can be done for patients now, Mount Sinai’s Tomey said,
“I would love to have the answer to that question.”
Elizabeth Cooney
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