OBJECTIVE: To evaluate the need for cardiac monitoring in unselected patients recovered from COVID-19 and to estimate the risk of heart complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MATERIALS AND METHODS: During March 2020 and January 2021, 106 patients who had recovered from SARS-CoV-2 (alpha and beta variants) were enrolled in prospective observational cohort study CoSuBr (Covid Survivals in Brno). The diagnosis was based on a reverse transcription-polymerase chain reaction swab test of the upper respiratory tract. Demographic parameters, patient history, clinical evaluation, cardiac biomarkers, ECG and echocardiography were recorded during three visits (Visit 1 at least 6 weeks after infection, Visit 2 three months later, and Visit 3 one year after Visit 1). RESULTS: 58.5% of the study group (n = 106) were female, while the mean age was 46 years (range 18-77 years). The mean time interval between the onset of infection and the follow-up visit was 107 days. One quarter (24.5%) of the patients required hospitalization during the acute phase of the disease; the rest recovered at home. 74% suffered a mild form of the disease, with 4.8, 18.1, and 2.9% suffering moderate, severe, and critical forms, respectively. At the time of enrolment, 64.2% of the patients reported persistent symptoms, while more than half of the whole group (50.9%) mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue). In the 1-year follow-up after COVID-19 infection, left ventricle ejection fraction showed no significant decrease [median (IQR) change was -1.0 (-6.0; 4.0)%, p = 0.150], and there were no changes of troponin (mean change -0.1 ± 1.72 ng/L; p = 0.380) or NT-proBNP [median (IQR) change 2.0 (-20.0; 29.0) pg/mL; p = 0.315]. There was a mild decrease in right ventricle end diastolic diameter (-mean change 2.3 ± 5.61 mm, p < 0.001), while no right ventricle dysfunction was detected. There was very mild progress in left ventricle diastolic diameter [median (IQR) change 1.0 (-1.0; 4.0) mm; p = 0.001] between V1 and V3, mild enlargement of the left atrium (mean change 1.2 ± 4.17 mm; p = 0.021) and a non-significant trend to impairment of left ventricle diastolic dysfunction. There was a mild change in pulmonary artery systolic pressure [median (IQR) change 3.0 (-2.0; 8.0) mmHg; p = 0.038]. CONCLUSION: Despite a lot of information regarding cardiac impairment due to SARS-CoV2, our study does not suggest an increased risk for developing clinically significant heart changes during the 1-year follow-up. Based on our results, routine echocardiography and biomarkers collection is currently not recommended after COVID-19 recovery.

Clinic of Pulmonary Disease and Tuberculosis University Hospital Brno Brno Czechia

Department of Internal Medicine and Cardiology University Hospital Brno Brno Czechia

Department of Pharmacology Masaryk University Brno Czechia

Department of Psychiatry University Hospital Brno Brno Czechia

Faculty of Medicine Masaryk University Brno Czechia

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Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute Covid-19 in primary care. BMJ. (2020) 370:m3026. 10.1136/bmj.m3026 PubMed DOI

Halpin S, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection. J Med Virol. (2021) 93:1013–22. 10.1002/jmv.26368 PubMed DOI

Scordo K, Richmond M, Munro N. Post-COVID-19 syndrome: theoretical basis, identification, and management. AACN Adv Crit Care. (2021) 32:188–94. 10.4037/aacnacc2021492 PubMed DOI

Zhang H, Zang C, Xu Z, Zhang Y, Xu J, Bian J, et al. Data-driven identification of post-acute SARS-CoV-2 infection subphenotypes. Nat Med. (2022) 1. 10.1038/s41591-022-02116-3 [Epub ahead of print]. PubMed DOI PMC

Richter D, Guasti L, Koehler F, Squizzato A, Nistri S, Christodorescu R, et al. Late phase of COVID-19 pandemic in general cardiology. A position paper of the ESC council for cardiology practice. ESC Heart Fail. (2021) 8:3483–94. 10.1002/ehf2.13466 PubMed DOI PMC

Puntmann V, Carerj M, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. (2020) 5:1265–73. 10.1001/jamacardio.2020.3557 PubMed DOI PMC

Wang W, Wang C, Wang S, Wei J. Long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population: a retrospective cohort study from the TriNetX US collaborative networks. EClinicalMedicine. (2022) 53:101619. 10.1016/j.eclinm.2022.101619 PubMed DOI PMC

Dhakal B, Sweitzer N, Indik J, Acharya D, William P. SARS-CoV-2 infection and cardiovascular disease. Heart Lung Circ. (2020) 29:973–87. 10.1016/j.hlc.2020.05.101 PubMed DOI PMC

Dweck M, Bularga A, Hahn R, Bing R, Lee K, Chapman A, et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging. (2020) 21:949–58. 10.1093/ehjci/jeaa178 PubMed DOI PMC

Amraei R, Rahimi N. COVID-19, renin-angiotensin system and endothelial dysfunction. Cells. (2020) 9:1652. 10.3390/cells9071652 PubMed DOI PMC

Wu X, Deng K, Li C, Yang Z, Hu H, Cai H, et al. Cardiac involvement in recovered patients from COVID-19: a preliminary 6-month follow-up study. Front Cardiovasc Med. (2021) 8:654405. 10.3389/fcvm.2021.654405 PubMed DOI PMC

Sechi L, Colussi G, Bulfone L, Brosolo G, Da Porto A, Peghin M, et al. Short-term cardiac outcome in survivors of COVID-19: a systematic study after hospital discharge. Clin Res Cardiol. (2021) 110:1063–72. 10.1007/s00392-020-01800-z PubMed DOI PMC

Sonnweber T, Sahanic S, Pizzini A, Luger A, Schwabl C, Sonnweber B, et al. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. Eur Respir J. (2021) 57:2003481. 10.1183/13993003.03481-2020 PubMed DOI PMC

Turan T, Özderya A, Şahin S, Konuş A, Kul S, Akyüz A, et al. Left ventricular global longitudinal strain in low cardiac risk outpatients who recently recovered from coronavirus disease 2019. Int J Cardiovasc Imaging. (2021) 37:2979–89. 10.1007/s10554-021-02376-z PubMed DOI PMC

Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. (2022) 28:583–90. 10.1038/s41591-022-01689-3 PubMed DOI PMC

Ramadan M, Bertolino L, Zampino R, Durante-Mangoni E. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review. Clin Microbiol Infect. (2021) 27:1250–61. 10.1016/j.cmi.2021.06.015 PubMed DOI PMC

Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. Spectrum of cardiac manifestations in COVID-19: a systematic echocardiographic study. Circulation. (2020) 142:342–53. 10.1161/CIRCULATIONAHA.120.047971 PubMed DOI PMC