Reassuring Data on Impact of Mild COVID-19 on the Heart

Megan Brooks

May 10, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Six months after mild SARS-CoV-2 infection in a representative healthcare workforce, no long-term cardiovascular sequelae were detected compared with a matched SARS-CoV-2 seronegative group.

"Mild COVID-19 left no measurable cardiovascular impact on LV structure, function, scar burden, aortic stiffness, or serum biomarkers," the researchers report in an article published online May 8 in JACC: Cardiovascular Imaging.

"We provide societal reassurance and support for the position that screening in asymptomatic individuals following mild disease is not indicated," first author George Joy, MBBS, University College London, UK, said in presenting the results at EuroCMR, the annual CMR congress of the European Association of Cardiovascular Imaging (EACVI).

Briefing co-moderator, Leyla Elif Sade, MD, University of Baskent, Ankara, Turkey, said, "This is the hot topic of our time because of obvious reasons and I think [this] study is quite important to avoid unnecessary further testing, surveillance testing, and to avoid a significant burden of healthcare costs."

"Alarming" Early Data

Early cardiac magnetic resonance (CMR) studies in patients recovered from mild COVID-19 were "alarming," Joy said.

As previously reported by theheart.org | Medscape Cardiology, one study showed cardiac abnormalities after mild COVID-19 in up to 78% of patients, with evidence of ongoing myocardial inflammation in 60%. The CMR findings correlated with elevations in troponin T by high-sensitivity assay (hs-TnT).

To investigate further, Joy and colleagues did a nested case-control study within the COVIDsortium, a prospective study of 731 healthcare workers from three London hospitals who underwent weekly symptom, polymerase chain reaction, and serology assessment over 4 months during the first wave of the pandemic.

A total of 157 (21.5%) participants seroconverted during the study period.

Six months after infection, 74 seropositive (median age, 39; 62% women) and 75 age-, sex-, and ethnicity-matched seronegative controls underwent cardiovascular phenotyping (comprehensive phantom-calibrated CMR and blood biomarkers). The analysis was blinded, using objective artificial intelligence analytics when available.

The results showed no statistically significant differences between seropositive and seronegative participants in cardiac structure (left ventricular volumes, mass, 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).

Cardiovascular abnormalities were no more common in seropositive than seronegative otherwise healthy healthcare workers 6 months post-mild SARS-CoV-2 infection. Measured abnormalities were "evenly distributed between both groups," Joy said.

Therefore, it's "important to reassure patients with mild SARS-CoV-2 infection regarding its cardiovascular effects," Joy and colleagues conclude.

Limitations and Caveats

They caution, however, that the study provides insight only into the short- to medium-term sequelae of patients aged 18-69 with mild COVID-19 who did not require hospitalization and had low numbers of comorbidities.

The study does not address the cardiovascular effects after severe COVID-19 infection requiring hospitalization or in those with multiple comorbid conditions, they note. It also does not prove that apparently mild SARS-CoV-2 never causes chronic myocarditis.

"The study design would not distinguish between people who had sustained completely healed myocarditis and pericarditis and those in whom the heart had never been affected," the researchers note.

They point to a recent cross-sectional study of athletes 1-month post-mild COVID-19 that found significant pericardial involvement (late enhancement and/or pericardial effusion), although no baseline pre-COVID imaging was performed. In the current study at 6 months post infection the pericardium was normal.

The co-authors of a linked editorial say this study provides "welcome, reassuring information that in healthy individuals who experience mild infection with COVID-19, persisting evidence of cardiovascular complications is very uncommon. The results do not support cardiovascular screening in individuals with mild or asymptomatic infection with COVID-19."  

Colin Berry, PhD, and Kenneth Mangion, PhD, both from University of Glasgow, Glasgow, Scotland, caution that the population is restricted to healthcare workers; therefore, the findings may not necessarily be generalized to a community population.

"Healthcare workers do not reflect the population of individuals most clinically affected by COVID-19 illness. The severity of acute COVID-19 infection is greatest in older individuals and those with preexisting health problems. Healthcare workers are not representative of the wider, unselected, at-risk, community population," they point out.

Cardiovascular risk factors and concomitant health problems (heart and respiratory disease) may be more common in the community than in healthcare workers, and prior studies have highlighted their potential impact for disease pathogenesis in COVID-19.

Berry and Mangion also note that women made up nearly two thirds of the seropositive group. This may reflect a selection bias or may naturally reflect the fact that proportionately more women are asymptomatic or have milder forms of illness, whereas severe SARS-CoV-2 infection requiring hospitalization affects men to a greater degree.

COVIDsortium funding was donated by individuals, charitable trusts, and corporations including Goldman Sachs, Citadel and Citadel Securities, The Guy Foundation, GW Pharmaceuticals, Kusuma Trust, and Jagclif Charitable Trust, and enabled by Barts Charity with support from UCLH Charity. The authors have disclosed no relevant financial relationships.

JACC Cardiovasc Imaging. Published online May 8, 2021. Abstract, Editorial

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