Cardiovascular events not uncommon in ICU-admitted COVID-19 survivors

One out of five severe COVID-19 survivors who underwent mechanical ventilation have coronary artery disease (CAD), a quarter have subclinical left ventricular dysfunction defined as reduced echocardiographic global longitudinal strain (GLS), and 42 percent have cardiac magnetic resonance (CMR) abnormalities, reports a study.

The investigators assessed the extent of cardiac sequelae after hospital discharge in patients surviving intensive care unit (ICU) hospitalization for COVID-19. They invited all survivors of Maastricht- ICU for comprehensive cardiovascular assessment 6 months after discharge from ICU. Cardiac screening included an electrocardiogram, cardiac biomarkers, echocardiography, CMR, and cardiac computed tomography or coronary angiogram.

Forty-two out of 52 survivors (81 percent) participated to the cardiovascular follow-up (median follow-up, 6 months). CAD was diagnosed in eight patients (19 percent), of which two needed a percutaneous intervention. Twenty-four percent had abnormal echocardiographic GLS, and 12 percent had abnormal CMR-derived GLS, despite normal left ventricular ejection fraction in all.

Of the patients, none exhibited elevated T₁ relaxation times, while five (14 percent) had an increased T₂ relaxation time. Eight patients (21 percent) had elevated late gadolinium enhancement reflecting regional myocardial fibrosis, of which three had myocarditis and three had pericarditis.

“On the basis of these findings, long-term cardiovascular follow-up is strongly recommended in all postintensive care COVID-19 patients,” the investigators said.

Cardiovascular risks and myocardial injury are associated with increased mortality in COVID-19, they noted.