Although widespread disease prevention strategies such as vaccination have proven significantly helpful in reducing COVID-19 transmission rates, much is still unknown regarding the consequences of the pandemic on various organ systems. As efforts to curb the spread of COVID-19 continue, new and emerging research continues to shed light on COVID-19’s unforeseen effects, particularly in the context of cardiovascular health. It is widely known that those with underlying cardiovascular disease are at a higher risk of developing severe infection and have a worse prognosis. However, COVID-19 itself is also directly damaging to the cardiovascular system through various mechanisms, including direct tissue injury and disruption of biochemical pathways. Advanced cardiac imaging modalities have been beneficial in the diagnosis of COVID-19 related cardiovascular complications, as well as risk stratification.
Transthoracic Echocardiography (TTE) is a non-invasive form of cardiac imaging which allows clinicians to view structural abnormalities in the heart. TTE can show whether heart muscles and valves are moving normally and effectively. A study involving 305 patients with COVID-19 demonstrated TTE abnormalities in two-thirds of patients with myocardial injury, and these abnormalities were independent predictive factors for mortality. Another imaging modality, cardiovascular magnetic resonance imaging (CMR), helps distinguish between ischemic and non-ischemic pathologies. In a prospective cohort study of 100 patients who had recently recovered from COVID-19 infection, CMR demonstrated that 78% of patients had cardiac involvement. Ongoing inflammation of cardiac tissue was present in 60% of patients. This finding was independent of pre-existing cardiovascular risk factors and the overall severity of their recent COVID-19 infection.
Although the exact clinical significance of advanced cardiac imaging findings in patients following recovery from COVID-19 infection remains to be seen, such modalities play an important role in the management of COVID-19 patients. These and similar findings will help guide the development of randomized controlled trials to better describe the long-term impact of COVID-19 infection on cardiovascular outcomes.
Sources: JACC, JAMA Cardiology