COVID-19 Might Damage the Hearts of Even Young, Healthy Patients

The effects of coronavirus disease 2019 (COVID-19) on the heart can possibly last a lifetime even in younger and healthier individuals, and there seems to be evidence that SARS-CoV-2 can cause inflammation in the heart, according to two studies in JAMA Cardiology. That doesn’t come as a complete surprise. Maureen Spencer, RN, M.Ed., told Infection Control Today® recently that the SARS-CoV-2 attacks ACE1 proteins. “Most of all your organs are aligned with this,” Spencer told ICT®. That’s why you’re seeing this virus attacking the brain, the liver, the GI system, not just the lungs. And it causes problems with the blood, the red blood cells. It’s different.”

Spencer didn’t happen to mention the heart, as being among those organs that COVID-19 affects, but two studies by German investigators do. Taken together, the studies, published in JAMA Cardiology, say that the disease can possible cause long-term damage to the heart even in patients who exhibited only mild symptoms from COVID-19.

One study looks at 100 patients who’d recently recovered from COVID-19, finding that 78 of those patients “revealed cardiac involvement” and 60 patients showed ongoing myocardial inflammation. These conditions were “independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis,” the study states.

Perhaps the most worrisome aspect of this study is that the subjects were relatively young; the average age was 49. Two-thirds of the cohort, whose acute COVID-19 severity had “ranged from asymptomatic to minor-to-moderate symptoms,” had recovered at home, whereas the remaining “severely unwell patients” had been hospitalized, the study states.

The investigators, most of who were from University Hospital Frankfurt, say that “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 toward reduction of imaging or serological findings during the recovery period.”

They add that one of the many unwanted byproducts of COVID-19 may be a growing population of people with heart problems.

In another study, investigators with the University Heart and Vascular Centre in Hamburg, extracted data from autopsy reports from 39 people whose average age was 85 and who had died when COVID-19 first struck. The investigators found high levels of the virus in 24 of the patients.

“In this study, 5 of 16 patients with virus load above 1000 copies, which we deem to be clinically significant, showed signs of viral replication within the myocardial tissue,” the study states. “This indicates not only virus presence but viral progeny.” An increased level of inflammation in the patients raises some concern.

Neither study could determine if COVID-19 could induce permanent heart damage in patients, but the results—especially from the study that looks at the younger, healthy chort—have given cardiologists pause.

One of them is Matthew Tomey, a cardiologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Health System in New York. (He was not involved in either study.)

He tells STAT that “the question now is how long these changes persist. Are these going to become chronic effects upon the heart or are these—we hope—temporary effects on cardiac function that will gradually improve over time?”

Tomey still sees patients who had COVID-19 back in March or April, when New York City was the nexus of the disease in the country.

He tells STAT: “Patients come to my office saying, ‘Hey, I’m a 31-year-old who used to run and be completely unlimited in my exercise, and now I get palpitations walking across the street. Or I get out of breath climbing up to my second-floor apartment,’” he said. “Individuals are exquisitely tuned in to their own capacity for exercise, so I take that very seriously. Our challenge is to understand the why.”