Heart infection fears for coronavirus sufferers

Scientists have raised a strong possibility of direct viral infection of the heart caused by COVID-19.

Scientists have raised a strong possibility of direct viral infection of the heart caused by COVID-19, saying ongoing cardiovascular disability could be the next wave of disease caused by the pandemic.

Two studies published in the Journal of the American Medical Association Cardiology documented the presence of SARS-CoV-2 within the heart muscle and associated inflammation.

That led scientists to conclude that heart damage was not an secondary symptom of COVID-19 but may be as a result of direct viral infection of the heart muscle.

The first study found that in 100 German patients who had recovered from COVID-19, 78 had abnormal heart readings on cardiac magnetic resonance imaging and 60 patients had signs of heart inflammation, independent of pre-existing conditions, severity and overall course of the acute illness, and the time from the original diagnosis.

The study said although the main emphasis of scientific research into COVID-19 had so far focused on acute respiratory complications, a small number of studies had suggested that COVID-19 prominently affects the cardio­vascular system by exacerbating heart failure in patients with pre-existing cardiac conditions. New data suggested heart damage was also experienced in those with no pre-existing conditions.

Of the 100 German patients studied who recovered from COVID-19, most experienced lower levels of blood being pumped from the heart with each heartbeat, higher left ventricle volume and mass, which affects the heart’s ability to pump blood.

Seventy-eight of the recovered patients had abnormal cardiac magnetic resonance findings, irrespective of pre-existing conditions, the severity and overall course of their COVID-19 illness.

Sixty of the patients had ongoing myocardial inflammation, and many had heart scarring.

Twelve of the patients had restricted blood supply to the muscles of the heart, and three patients had severe heart abnormalities.

“To our knowledge, this is the first prospective report on a cohort of unselected patients with a recent COVID-19 infection identified from a local testing centre who voluntarily underwent evaluation for cardiac involvement with cardiac magnetic resonance imaging,” the study’s authors said.

“The results of our study provide important insights into the prevalence of cardiovascular involvement in the early convalescent stage. Our findings demonstrate that participants with a relative paucity of pre-­existing cardiovascular condition and with mostly home-based recovery had frequent cardiac inflammatory involvement, which was similar to the hospitalised subgroup with regards to severity and extent.

“Unlike previous studies, our findings reveal that significant cardiac involvement occurs independently of the severity of original presentation and persists beyond the period of acute presentation, with no significant trend towards reduction of imaging or serological findings during the recovery period. Our findings may provide an indication of potentially considerable burden of inflammatory disease in large and growing parts of the population and urgently require confirmation in a larger cohort.”

The second study, also by German scientists, analysed the cardiac tissue of 39 people who had died from COVID-19, and found the virus was present within the heart muscle in 24 patients.

An accompanying editorial in JAMA Cardiology said if further studies confirmed the high rate of heart risk documented by these studies, the COVID crisis would shift to a one of heart failure and other chronic cardiovascular complications.

“These new findings provide intriguing evidence that COVID-19 is associated with at least some component of myocardial injury, perhaps as the result of direct viral infection of the heart,” the editorial said.

“We see the plot thickening and are inclined to raise a new, very evident concern that cardio­myopathy and heart failure related to COVID-19 may evolve as the natural history of this infection becomes clearer.”