This is the largest study on new signs and symptoms of cardiac failure in patients after COVID-19. Even though low in prevalence, its occurrence in healthy patients with no prior risk factors is worrying.
The potential for SARS-CoV 2 to directly affect the heart has been studied since the pandemic onset. These studies have shown different outcomes, to the point that some have confirmed myocarditis and others have ruled it out.
The present study included 6500 patients (mean age 64) with confirmed COVID-19 infection admitted to Mount Sinai Hospital. Only 37 presented symptoms and signs of new heart failure.
Some of them presented predisposing factors, and therefore the virus was just the straw that broke the camel. But there was a group of young patients with no prior risk factors.
In these patients the diagnosis of heart failure during hospitalization was based on the presence of 2 of these 3 symptoms: brain natriuretic peptide (BNP) levels, chest x-ray compatible with heart failure and systolic or diastolic dysfunction by ECG.
Half the cohort presented prior risk factors and the other half were healthy and young.
These healthy young patients more often presented elevated troponin levels, elevated BNP, shock and acute coronary syndrome.
Even though possible, new heart failure is rare, and therefore there is no followup scheme, especially in the younger subgroup.
Cardiopulmonary tests might be useful to identify a pulmonary or cardiac cause for the shortness of breath.
This study provides significant data and even more questions about followup of this cohort of young healthy patients who developed heart failure post COVID-19 infection.
Reference: Alvarez-Garcia J et al. J Am Coll Cardiol. 2021 May, 77 (17) 2260–2262.