Patients who continue to experience breathlessness on physical activity even after one year of recovering from Covid-19 may have sustained some residual heart damage, suggests a new study from Belgium, presented at EuroEcho 2021, the annual echocardiography conference of the European Society of Cardiology (ESC).^1,2

Sixty-six patients, with no past history of any cardio-pulmonary disease, were selected for the study to detect any subclinical heart dysfunction in those complaining of dyspnea. Around 67% of participants were men; 23 patients (35%) had dyspnea as part of long Covid. Their average age was 50 years. These patients had been hospitalized with Covid-19 between March and April 2020 at University Hospital Brussels. Spirometry and chest CT scan was done at one-year post-discharge to evaluate pulmonary functions and detect any residual lung damage. Assessment of cardiac function was done by ultrasound and myocardial work, a new echocardiography-based measure of cardiac function. Global work index (GWI) and global constructive work (GCW) were used to evaluate myocardial work performance.

Results showed that compared to patients with no dyspnea, those who had persistent dyspnea at one year after recovery displayed diminished heart function on cardiac imaging as measured by GWI and GCW (OR 0.998) after adjusting for age and gender. At 9 months, the  probability of having a normal respiratory pattern also showed a reduction (OR 0.195). Almost half of the patients showed myocarditis and ischemic injury at one- and two months after hospital discharge. Although more than a quarter of the participants had residual glass opacities at 6 months and 10% had pulmonary fibrosis at one year, no association was observed with dyspnea.

The findings of this study show a significant association of subclinical cardiac dysfunction incurred due to Covid-19 and persistent breathlessness during physical activity one year. Such patients require long-term regular monitoring. It proposes a likely explanation of why some long Covid patients continue to experience shortness of breath even after recovering from the infection. All patients should undergo cardiac evaluation using myocardial work as a new diagnostic aid for early identification of abnormalities in heart function. Such patients require long-term regular monitoring.

References

1. Luchian M-L. Persistent dyspnea 1 year after COVID -19 infection in apparently healthy subjects: a potential indicator of subclinical cardiac dysfunction. Presented at: EuroEcho 2021; December 9-11, 2021. https://www.escardio.org/The-ESC/Press-Office/Press-releases/breathlessness-in-patients-with-long-covid-may-signal-heart-problems
2. https://www.ajmc.com/view/investigators-ask-if-covid-19-infection-is-to-blame-for-cardiac-dysfunction.