Background

Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease.

Objectives

To assess the range of cardiac sequelae after COVID-19 recovery.

Data sources

PubMed, Embase, Scopus (inception through 17 February 2021) and Google scholar (2019 through 17 February 2021).

Study eligibility criteria

Prospective and retrospective studies, case reports and case series.

Participants

Adult patients assessed for cardiac manifestations after COVID-19 recovery.

Exposure

Severe acute respiratory syndrome coronavirus 2 infection diagnosed by PCR.

Methods

Systematic review.

Results

Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52 609 patients were included. Twenty-nine studies used objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in 16 studies, echocardiography in 15, electrocardiography (ECG) in 16 and cardiac biomarkers in 18. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1–180 days). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (11%) on CMR, with symptoms such as chest pain (25%) and dyspnoea (36%). In the medium term (3–6 months), common changes included reduced left ventricular global longitudinal strain (30%) and late gadolinium enhancement (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated N-terminal proB-type natriuretic peptide (18%). In addition, COVID-19 survivors had higher risk (risk ratio 3; 95% CI 2.7–3.2) of developing heart failure, arrythmias and myocardial infarction.

Conclusions

COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.

中文翻译：

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2019年冠状病毒病康复后的心脏后遗症：系统评价

 背景

2019 年冠状病毒病 (COVID-19) 与疾病急性期后的多种心脏表现有关。

 目标

评估 COVID-19 康复后心脏后遗症的范围。

 数据来源

PubMed、Embase、Scopus（成立至 2021 年 2 月 17 日）和 Google 学术（2019 年至 2021 年 2 月 17 日）。

学习资格标准

前瞻性和回顾性研究、病例报告和病例系列。

 参加者

成年患者在 COVID-19 康复后评估心脏表现。

 接触

通过 PCR 诊断严重急性呼吸综合征冠状病毒 2 感染。

 方法

 系统审查。

 结果

纳入了 35 项研究（15 项前瞻性队列、7 项病例报告、5 项横断面研究、4 项病例系列、3 项回顾性队列和一项双向队列），评估了 52 609 名患者的心脏后遗症。 29 项研究使用客观心脏评估，其中 16 项研究主要采用心脏磁共振成像 (CMR)，15 项研究采用超声心动图，16 项研究采用心电图 (ECG)，18 项研究采用心脏生物标志物。大多数研究都存在相当大的偏倚风险。从诊断/康复到心脏评估的中位时间为 48 天（1-180 天）。常见的短期心脏异常（<3个月）包括CMR上T1增加（比例：30%）、T2（16%）、心包积液（15%）和晚期钆增强（11%），并伴有胸痛等症状(25%) 和呼吸困难 (36%)。在中期（3-6个月），常见的变化包括左心室整体纵向应变减少（30%）和CMR晚期钆增强（10%）、超声心动图舒张功能障碍（40%）和N端proB-升高型利尿钠肽（18%）。此外，COVID-19幸存者发生心力衰竭、心律失常和心肌梗死的风险较高（风险比3；95% CI 2.7-3.2）。

 结论

COVID-19 似乎与恢复后持续性/新发心脏损伤有关，特别是早期的亚临床心肌损伤和后期的舒张功能障碍。需要进行更大规模、精心设计和对照的研究以及基线评估，以更好地衡量心脏损伤的程度及其临床影响。