COVID-19 myocarditis and prospective heart failure burden

ABSTRACT

Introduction: COVID-19 is causing considerable morbidity and mortality worldwide. Serious respiratory complications aside, the heart is also frequently involved. The mechanisms and the extent of the myocardial injury, along with the short and long-term cardiovascular (CV) outcomes in COVID-19 survivors remain unclear.

Areas covered: myocardial injury has been found in a considerable proportion of hospitalized COVID-19 patients and is associated with a worse prognosis. The late onset of CV complications with myocarditis-like changes revealed by CMR has been reported in COVID-19 survivors. Previous observational studies on viral myocarditis provide evidence of a significant incomplete recovery with residual dysfunction and remodeling of left ventricle. Incomplete recovery is thought to be the result of persistent myocardial inflammation due to a post-viral autoimmune response. Considering the significant inflammatory nature of COVID-19, COVID-19 survivors may be at risk of developing persistent residual myocardial injury, the sequelae of which are unclear.

Expert commentary: COVID-19 is an emerging threat for the heart. The extent of CV injury, along with the short and long-term sequelae, requires further investigation. The early detection of residual myocardial changes in COVID-19 survivors is of utmost importance in order to identify those patients at risk of CV complication development.

KEYWORDS:

• COVID-19
• myocarditis
• cardiac magnetic resonance
• heart failure

Article highlights

• Myocardial injury is common in COVID-19 patients and occurs irrespective of the severity of the initial presentation.

• Given the significant inflammatory nature of the COVID-19 infection, residual myocardial inflammation may occur frequently in COVID-19 survivors and predispose CV complications, particularly heart failure.

• Early detection of myocardial injury in COVID-19 survivors, which may facilitate HF development, is of utmost importance.

• CMR mapping techniques allow us to distinguish between healthy and diseased myocardium, monitor healing processes, as well as guide treatment.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.