Cardiovascular Repercussions Caused by COVID-19

Heart failure patients are at significantly elevated risk of a COVID-19 infection, but also fully healthy individuals have a substantially elevated risk of cardiovascular complications within the first year after even a mild infection.

A recent article on the Acorai blog focused on how the Sars-CoV-2 pandemic has reshaped the clinical management of heart failure, and this follow-on post intents to shed light on the elevated risk of twenty identified diseases of the heart and blood vessels caused by the pandemic – ever for those with asymptomatic COVID-19.

Image 1: The risk of 20 diseases of the heart and blood vessels is high for at least a year after a COVID-19 diagnosis.

Recently published evidence revealed that just about any healthy individual infected with COVID-19 is at risk of cardiological complications – for instance, heart inflammation, cardiovascular clotting or arrhythmias. A very large study (n>5 million), published in early 2022 showed an extended and significant risk elevation of cardiovascular problems, e.g., heart attacks and stroke, after a SARS-CoV-2 infection – even after a mild infection.[1]

During autumn 2022 frequencies of these issues and their aetiology were presented in several studies. It has been confirmed previous cardiac issues, hypertension, diabetes, male gender, age over 65 and obesity are significant risk factors. Twenty cardiovascular complications were identified as starkly more prevalent in people who had undergone a COVID-19 infection, e.g., a 52% increased risk of stroke, and of heart failure 72% the following year.[2]

However, patients admitted to the ICU with acute COVID-19 runs a dramatically higher risk of cardiovascular issues during the first-year post infection. These patients have a twenty-fold increased risk of cardiac oedema and pulmonary embolism.[3]

Moreover, people with previous uncomplicated COVID-19 who had not been hospitalized had also increased risks of several cardiovascular events, e.g., 247%  increased risk of myocarditis and an 8% increase in the rate of a heart attack the following year.

 

A Veterans Affairs (VA) study was published in 2022 and compared 150,000 patients who had recovered from acute COVID-19, with uninfected people and pre-pandemic controls.[4] Image 2 presents and overview of the cardiovascular conditions at increased risk in the first year after a COVID-19 infections – note the difference if the patients were hospitalised or not, or if they were admitted to the ICU. The conditions include cerebrovascular problems (e.g., stroke), dysrhythmia (e.g., atrial fibrillation), inflammatory heart disease (e.g., heart oedema), ischaemic heart disease (e.g., heart attacks), other cardiac disorders (e.g., heart failure) and major adverse cardiac events.

Coxsackieviruses are notoriously known for causing myocarditis, but the heart infection caused by COVID-19 does very seldom give rise to any cardiac symptoms. This phenomenon has been coined the post-COVID-19 cardiac syndrome.[6]

Image 2: An overview of the significantly increased risks of cardiovascular complications after a COVID-19 infection.

That COVID-19 causes heart complications was known from the onset of the pandemic – acute heart failure, arrhythmias and blood clotting are ubiquitous among patients admitted to hospital for care.[7] The SARS-CoV-2 spike binds to its receptor human ACE2 (hACE2). The ACE2 receptor involved in the SARS-CoV-2 invasion is abundant in both lung and cardiac tissues.[8] As depicted in image 3 the virus causes the cardiac muscle fibres to break – the broken contractility explains the long-term heart problems.

 

Image 3: A healthy cardiac muscle tissue (left) with long contractible fibres, which are ruptured by SARS-CoV-2 (right). The extended negative effects on the cardiac function in patients with post-COVID-19 cardiac syndrome may be explained with this image.

Endomyocardial biopsy represents the diagnostic gold standard for its diagnosis but is infrequently used. The routine diagnostics hence is cardiac MRI, which is an expensive procedure.[9] It won’t be feasible to scan all post-COVID-19 patients with MRI, but maybe other more easily distributed monitoring devices could be suitable to select the patients, which should undergo more advanced diagnostics. Further research could reveal if there are, e.g., early asymptomatic changes in intracardiac pressure, which could be detected with a wireless intracardiac pressure monitor (ICPM). If such a monitor, together with other triaging factors, such as pulse-oximetry, blood pressure, temperature and clinical key sign, an AI model for the detection of asymptomatic heart complications caused by COVID-19 could perhaps be created. Future studies are yet to determine the feasibility. For instance, it could be investigated if a wireless ICPM could help monitoring the patients previously admitted to ICU with COVID-19, since they run a very high risk of both cardiac and pulmonary complications in the first year.

Finally, it has recently been debated if reinfections and the Omicron variant of SARS-CoV-2 pose any new cardiovascular threats. May and colleagues suggest that the vaccination decreases the risk of long-term complications but does not eliminate these.(8)

The next article on the Acorai blog will present an overview of the AI applications relevant to heart failure management.