“For months now, we’ve been realizing that Covid-19 is not only an infection of the airways, but also of many systems,” said cardiologist Dr. Nieca Goldberg, NYU Women’s Heart Program Medical Director and Senior Women’s Health Strategy Advisor. In New York, NYU Langone Health, which did not participate in any of the studies.
“There is an acute inflammatory response, increased blood clotting and heart activity. And heart activity may be due to the direct impact of the heart muscle on the infection and its inflammatory response. It may be due to blood clots causing arterial obstruction,”; Goldberg said.
“Sometimes people have very fast heart rhythms that can weaken the heart muscle over time, reduce the function of the heart muscle. So there are several ways this infection can involve the heart.”
Inflammation of the heart
The study involved patients aged 45 to 53 years who were from the University of Frankfurt Hospital Hospital Covid-19 in Germany. They were recruited for the study from April to June. Most patients (67 years of age) recovered at home when their disease severity ranged from asymptomatic to moderate.
The researchers used cardiac magnetic resonance imaging, blood tests, and heart tissue biopsy. These data were compared with a group of 50 healthy volunteers and 57 volunteers with certain health conditions or risk factors.
MRI data revealed that the heart rate of people infected with coronavirus was somehow, regardless of previous illness, severity or course of infection, time from initial diagnosis, or any specific heart-related symptoms.
The most common heart disorder in Covid-19 patients was myocardial inflammation or abnormal inflammation of the heart muscle, which may weaken it.
This type of inflammation, also called myocarditis, is most commonly caused by a viral infection, Goldberg said, adding that the results of the study did not surprise her.
“What they say in this study is that you can determine myocardial or cardiac involvement by magnetic resonance imaging,” Goldberg said.
The study has some limitations. More research is needed to determine whether similar findings will occur in a larger group of patients, patients under the age of 18 and those currently battling coronavirus infection, rather than just recovering.
“These findings suggest that the long-term effects of COVID-19 on cardiovascular disease need to be investigated on an ongoing basis,” the researchers wrote.
“This infection goes a long way”
The study included data from 39 autopsy cases from Germany from April 8 to 18. Patients aged 78 to 89 years tested positive for Covid-19, and the researchers analyzed heart tissue at necropsy.
The researchers found that 16 patients had virus in their heart tissue, but no evidence of unusual signs of sudden heart inflammation or myocarditis. It is unclear what that means, the researchers said.
The sample of autopsies was small, and “the elderly age of the patients may have affected the results,” the researchers wrote. More research is needed to see if similar findings occur in a younger group of patients.
“I think both of these studies are important,” Goldberg said.
“One of them shows that an MRI scan can help diagnose myocardial damage caused by Covido, and this has been confirmed by biopsy,” she said. “The autopsy study showed us something else interesting – that you can get a virus, but not an acute inflammatory process. So this infection goes a long way.”
“An increasingly difficult puzzle”
Both studies “add to an increasingly complex puzzle” when it comes to a new coronavirus called SARS-CoV-2, Dr. Montgomery, a cardiologist at the PREvent Clinic in Sandy Springs, Georgia, said in an email on Tuesday.
“In general, studies confirm that SARS-CoV-2 does not have to cause clinical myocarditis in order to find a large virus and an inflammatory response in myocardial tissue. In other words, there can be no or mild symptoms of heart involvement to actually cause harm.” said Montgomery, who did not participate in the investigation.
“Viruses usually have a pathway to enter organs that are quite distant from the original site of infection. SARS-CoV-2 is no different in this regard,” he said. The difference is that this virus appears to affect the heart and surrounding cells. These studies show that the heart can be infected without clear signs. Personally, in my practice, we have seen similar signs of inflammation, including pericardial effusions. Or fluid around the sac.
“We see the story thickening and we tend to raise new and very obvious concerns that cardiomyopathy and heart failure associated with COVID-19 may develop when the natural history of this infection becomes clear,” Yancy and Fonarow wrote to the editorial staff.
“We want not to cause additional concern, but rather to encourage other researchers to look closely at existing data and prospectively collect new data in other populations to confirm or refute these findings,” they wrote.