Table 1.
Prevalence of cardiac abnormalities in studies (n > 50) that utilized echocardiography, cardiac magnetic resonance, and cardiopulmonary exercise test during follow-up of COVID-19 patients
| First author | No. of patients | Age | Patient characteristics | Follow-up time | Controls | Cardiopulmonary symptoms | Echo findings |
|---|---|---|---|---|---|---|---|
| Echocardiography | |||||||
| Hall et al.135 | 200 | 55 ± 15 years; 62% male | Hospitalized patients; 27.5% mechanical ventilation | 4–6 weeks post-discharge | – | 18% new-onset/worsening of dypsnoea | 14% had either newly diagnosed or previously present abnormalities |
| Sechi et al.130 | 105 | 57 ± 14 years; 53% male | Hospitalized; 26% mechanical ventilation | Median 41 days post-symptom onset | 105 matched controls | 5% chest pain, 5% dyspnoea, 7% fatigue | No cardiac abnormalities |
| Catena et al.116 | 105 | 57 ± 14 years; 53% male | Hospitalized patients; 26% mechanical ventilation | Median 41 days post-symptom onset | – | 5% chest pain, 5% dyspnoea, 7% fatigue | No differences in cardiac function between troponin+ and troponin− COVID-19 patients |
| de Graaf et al.131 | 81 | 61 ± 13 years; 63% male | Hospitalized patient; 41% mechanical ventilation | 6 weeks post-discharge | – | 62% dyspnoea, 14% chest pain, 32% limited functional status | 18% LV dysfunction, 10% RV dysfunction |
| Moody et al.125 | 79 | 57 ± 11 years; 74% males | Hospitalized patients; 80% mechanically ventilated | 3 months post-discharge | – | – | 9% LV dysfunction, 14% RV dysfunction, 3% dilated LV, 9% dilated RV, 4% pericardial effusion |
| Sonnweber et al.109 | 145 | 57 ± 14 years; 57% males | 75% hospitalized; 22% ICU admission | 60 days and 100 days post-symptom onset | – | 36% dyspnoea | 3% LV systolic dysfunction—60 and 100 days, 55% diastolic dysfunction—60 days, 60% diastolic dysfunction—100 days, 10% pulmonary hypertension—60 and 100 days. Pericardial effusion 6% at 60 days and 1% at 100 days |
| CMR | |||||||
| Kotecha et al.101 | 148 | 64 ± 12 years; 70% male | Severe COVID-19 and elevated troponin; 32% mechanically ventilated | Median 68 days post-discharge or confirmed diagnosis | 40 co-morbidity matched and 40 healthy | No symptoms | 11% LV dysfunction, 26% myocarditis, 23% ischaemia/infarction, 6% had dual pathology |
| Puntmann et al.122 | 100 | 49 ± 14 years; 53% male | 67% non-hospitalized | Median 71 days post-positive COVID-19 test | 50 healthy and 57 co-morbidity matched controls | 36% breathlessness, 17% chest pain, 20% palpitations | 60% myocardial inflammation, 78% any abnormality including LV, RV dysfunction, late gadolinium enhancement, and pericardial enhancement |
| Raman et al.120 | 58 | 55 ± 13 years; 59% male | Hospitalized patients; 21% mechanically ventilated | 2–3 months post-symptom onset | 30 co-morbidity matched controls | 89% cardiopulmonary symptoms | No evidence of active myocardial oedema, no significant difference in scar burden with controls. Native T1 was elevated in 26% |
| Dennis et al.121 | 201 | 45 (21–71 years); 29% male | 19% hospitalized | Median 141 day post-symptom onset | 36 healthy controls | 98% fatigue, 88% breathlessness, 76% chest pain | 9% systolic dysfunction, 19% myocarditis |
| Zhou et al.112 | 97 | 47 ± 19 years; 54% male | Hospitalized patients (non-ventilated) | 2–4 weeks after discharge | – | – | All patients had echo. 1% LV dysfunction. CMR in four patients. One had subepicardial hyper-enhancement with no elevated T2 |
| Joy et al.128 | 74 | 39 (30–48 years); 38% male | Healthcare workers with predominantly mild infection; 3% hospitalized | 6 months post-infection | 75 SARS-CoV-2 antibody negative healthcare workers | 11% symptomatic, 3% sore throat, 3% fatigue, 2% breathlessness | 4% myocarditis like scar |
| Knight et al.114 | 29 | 64 ± 9 years; 83% male | Hospitalized with elevated troponin, 34% mechanically ventilated | Mean 46 days post-symptom onset | – | – | 69% had pathology, 3% mild LV dysfunction, 3% severe biventricular dysfunction, 38% non-ischaemic injury, 17% ischaemic injury, 14% dual pathology, 7% pericardial effusion |
| Eiros et al.124 | 139 | 52 (41–57 years); 28% male | Healthcare workers; 16% hospitalized | Median 10.4 weeks post-symptom onset | – | 27% fatigue,19% chest pain, 14% palpitations | 75% had CMR abnormalities, 4% oedema on T2, 42% T1, 37% extracellular volume, 30% pericardial effusion, 5% LV dysfunction, 14% had pericarditis, 37% had myocarditis, 11% fulfilled criteria for both pericarditis and myocarditis |
| Myhre et al.133 | 58 | 56 (50–70 years); 56% male | Hospitalized; 19% mechanically ventilated | Median 175 days | 32 healthy controls | 64% fatigue, 55% dyspnoea, 4% chest pain | 21% had pathology on CMR, 5% LV dysfunction, 17% late gadolinium enhancement |
| CPET | |||||||
| Clavario et al.102 | 110 | 62 (54–69 years); 59% male | Hospitalized (excluded pts requiring mechanical ventilation/ICU) | 3 months post-hospital discharge | – | 74% at least one symptom. 50% dyspnoea, 26% chest pain, 49% fatigue, 23% palpitations | Median predicted pVO2 90.9 (79.2–109). 35% had pVO2 < 80% predicted. DLE maximal strength independently associated with pVO2. 24% had cardiac limitation to exercise, 8% respiratory and cardiac, 47% non-cardiopulmonary limitation |
| Rinaldo et al.115 | 75 | Mean 57 years; 57% males | Hospitalized (39 critical, 18 severe, 18 mild–moderate disease) | Mean 97 days from discharge | – | 52% had dyspnoea with normal activity | Mean pVO2 83% of predicted. 55% pVO2 < 85% of predicted. VE/VCO2 slope 28 ± 13. Patients with reduced exercise capacity had normal breathing reserve, 17% had circulatory limitation (heart rate reserve <15%), 20% reduced AT (<45%). Patients with a reduced exercise capacity showed an early AT, indicating a higher degree of deconditioning, lower peak oxygen pulse, reduced VO2/WR slope |
| Raman et al.120 | 58 | 55 ± 13 years; 59% male | Hospitalized patients at 3 months from symptom onset | 3 months from symptom onset | 30 co-morbidity matched controls | 83% had at least one cardiopulmonary symptom | 55% had pVO2 < 80% predicted, VE/VCO2 slope 33.29–40 HRR in first minute was slower in patients compared with controls |
Data are presented as mean ± standard deviation or median (interquartile range).
AT, anaerobic threshold; BMI, body mass index; COVID, coronavirus disease; CMR, cardiac magnetic resonance; CPET, cardiopulmonary exercise test; DLco, carbon monoxide gas transfer; GLS, global longitudinal strain; HRR, heart rate recovery; ICU, intensive care unit; LV, left ventricle; PCR, polymerase chain reaction; pVO2, peak oxygen consumption; RV, right ventricle; PAP, pulmonary artery pressure; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; VE/VCO2, slope ventilatory equivalent for carbon dioxide; WR, work rate.