Skip to Main Content

Heart Health Explained

COVID-19 and Heart Health

©Albina Sazheniuk/bigstock.com
A pair of studies published July 27, 2020 in JAMA Cardiology found evidence of how the virus that causes COVID-19 might affect the heart.

COVID-19 and Heart Health Q&A

COVID-19 and Heart Health: Study One
The first study examined magnetic resonance imaging of patients who recently recovered from COVID-19 and found evidence of damage to the heart.
What’s the most important thing people should know about this study as it relates to their health?
This study demonstrates significant cardiac involvement and ongoing heart muscle inflammation in some patients with recent COVID–19 illness.
What was this study seeking to determine? Has this been done before?

This was a study of 100 patients diagnosed with severe COVID-19. The study evaluated the presence of heart muscle injury in patients recently recovered from COVID-19 illness by looking at heart muscle tissue characteristics using cardiac magnetic resonance imaging (CMR).

What were the results?
When compared with healthy people and people with similar risk factors for heart disease, patients recently recovered from COVID-19 had lower heart muscle function and higher left heart muscle volume and mass. They also had elevated inflammatory markers of the heart. Of the patients who recovered from COVID-19 infection, 78 percent had abnormal results involving the heart as detected by standardized CMR, regardless of pre-existing conditions. The most frequent abnormality was heart muscle inflammation detected by abnormal tissue characteristics in 60 percent of patients who recently recovered from COVID-19. Some patients did have scarring of the heart muscle and pericardium.
Did the study reveal any differences concerning subgroups?
Participants with only a few pre-existing conditions that put them at higher risk for cardiovascular disease and with mostly home-based recovery had frequent cardiac inflammation, which was similar to the hospitalized subgroup with regards to severity and extent. The sample size was small, and the researchers made no analysis of any differences between sexes.
What were the strengths and shortcomings of this study’s design and execution?
This was the first prospective observational study of a group of unselected patients with recent COVID-19 infection who voluntarily underwent evaluation for cardiac involvement with CMR. Patients with COVID-19 were compared with age-matched and sex-matched control groups of adults not taking any cardiac medications and who had normal cardiac imaging studies. Comparison were also made with patients matched for age, sex, hypertension, diabetes, and smoking — all known risk factors for coronary artery disease.

The findings are not validated for patients younger than 18 years of age. The study did not include patients during acute COVID-19 infection or those who were completely asymptomatic from COVID-19. Several of the patients in the study had persistent symptoms, increasing the likelihood of CMR imaging showing abnormal results.
What, if anything, should people and health care professionals do differently in the face of these findings? What are the challenges to addressing this issue?

Health care professionals should be aware that significant cardiac involvement can occur independently of the severity of the original COVID-19 presentation and can persist beyond the period of acute COVID-19 presentation. The findings suggest a potential considerable burden of inflammatory heart disease in large groups of patients recovering from COVID-19 illness. In these patients, initial and follow-up imaging and blood tests should be considered.

Challenges to address these issues are large. We do not know the long-term outcome of these findings. The number of patients recovering from COVID-19 illness is growing, and access to advanced imaging may be limited.

COVID-19 and Heart Health: Study Two
The second study looked at autopsy results of patients who died of COVID-19 and found evidence of the coronavirus in the hearts of most of the patients.
What’s the most important thing people should know about this study as it relates to their health?
In a small number of patients who died from COVID-19 and had an autopsy, cardiac infection with SARS-CoV-2, the virus that causes the disease, was frequently found but not associated with inflammation of the heart muscle.
What was this study seeking to determine? Has this been done before?

The study was seeking to evaluate the presence of SARS–CoV-2 in the heart muscle tissue from autopsy cases and to document a possible cardiac response to that infection. This had not been studied before.

What were the results?
Cardiac tissue from 39 consecutive autopsy cases of individuals who died from SARS-CoV-2 infection were included in the study. Pneumonia was determined as a cause of death in most of these individuals. SARS–CoV-2 could be documented in 61.5 percent of the patients. Viral load could be documented in 41 percent. None of the patients in the study were diagnosed as having clinically significant heart muscle inflammation.
Did the study reveal any differences concerning subgroups?
They did not describe any differences concerning subgroups. The median age of the individuals was 85, and 59 percent were woman.
What were the strengths and shortcomings of this study’s design and execution?
The study design was an autopsy study, with limited clinical information. The advanced age of the patients might have influenced the results. Heart muscle biopsies of the patients were not available in significant numbers.
What, if anything, should people and health care professionals do differently in the face of these findings? What are the challenges to addressing this issue?

Although significant inflammation of the heart muscle has been reported in some patients with SARS–CoV-2 infection, this study indicates that the presence of the virus in cardiac tissue does not necessarily cause an inflammatory reaction consistent with clinically significant inflammation of the heart muscle.

It is unknown whether heart muscle viral activity in the absence of clinical evidence of inflammation of the heart muscle results in long-term consequences.

HEALTH NEWS IN PERSPECTIVE

Answers to your questions on timely topics in cardiac care to help make sense of research reports in the media. The series includes questions on your heart and the effect of medications, exercise, diet, and hormones.

Team Specialist

Jayanta Mukherjee, MD, FACC, OhioHealth Health System

Q&A Editor

Teresa Caulin-Glaser, MD, FACC, FAACVPR System Vice President, Heart & Vascular Services OhioHealth Healthcare System, Columbus, Ohio

Heart Health Explained is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.