Cardiovascular Consequences of COVID-19 in Healthy Subjects

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In 2023, the World Health Organization (WHO) Director-General made the determination that COVID-19 is no longer a public health emergency of international concern but acknowledged it as an established and ongoing health issue.

The consequences of COVID-19 infection extend beyond respiratory symptoms and have significant implications for cardiovascular health worldwide. Hospitalized patients with COVID-19 often experience acute cardiac complications that can range from mild to severe.

Some of the acute cardiac complications observed in patients with COVID-19 include acute heart failure, cardiogenic shock, myocardial ischemia or infarction, left ventricular dysfunction, right ventricular dysfunction, biventricular dysfunction, stress cardiomyopathy, arrhythmias, venous thromboembolism, and arterial thrombosis secondary to virus-mediated coagulopathy [2].

These complications highlight the wide-ranging impact of COVID-19 on the cardiovascular system.

It is important to note that there is limited information available on the effects of COVID-19 on the cardiovascular health of healthy individuals. Most research has focused on patients with pre-existing cardiovascular conditions or severe COVID-19 cases. Consequently, there is a scarcity of data on healthy individuals who have had COVID-19.

However, previous studies have provided insights into the potential effects of viral infections on cardiac function. For example, research has demonstrated that adenovirus infection can be an etiological factor in the development of atrial fibrillation [3]. This suggests that viral infections, including COVID-19, may have detrimental effects on cardiac function due to various mechanisms involving transcriptional and posttranslational modifications that disrupt gap junctions, influence immune response, or contribute to the development of cardiomyopathy during active infection [4].

To further understand the impact of COVID-19 on cardiovascular health in healthy individuals, a study was conducted comparing echocardiographic characteristics and routine blood markers in participants who were recruited for a study unrelated to COVID-19 between 2019 and 2021 [5].

The recruitment of this cohort began before the pandemic and continued during the pandemic, allowing for a comparative analysis of participants who tested positive for immunoglobulin G antibodies against severe acute respiratory syndrome-linked coronavirus (IgG-SARS) and those who tested negative.

The findings of this study shed light on the cardiovascular consequences of COVID-19 in healthy individuals. The left ventricular mass index (LVMI), a measure of the size and mass of the left ventricle, was found to be decreased in participants who tested positive for SARS antibodies.

Additionally, parameters related to diastolic function, such as the E/A ratio (assessing left ventricular filling pressure) and deceleration time (DT) of early mitral inflow, were also found to be decreased in the SARS-positive group. These findings suggest that COVID-19 may affect diastolic function and contribute to the development of cardiovascular complications.

The study also investigated the impact of COVID-19 on blood markers. Platelet count was slightly increased in SARS-positive participants, indicating potential platelet activation and its contribution to thrombotic events observed in COVID-19 patients.

The erythrocyte sedimentation rate (ESR), a marker of systemic inflammation, was elevated in the SARS-positive group, indicating persistent inflammation even in healthy individuals who had recovered from COVID-19.

Viral Infections and Cardiac Function

Previous studies have shown that viral infections, such as adenovirus, can have detrimental effects on cardiac function. These effects are believed to be mediated through transcriptional and posttranslational modifications that disrupt gap junctions, influence immune response, or contribute to the development of cardiomyopathy during active infection. Given these findings, it is plausible that COVID-19, being a viral infection, may also have an impact on cardiac function in healthy individuals.

Echocardiography as a Diagnostic Tool

Echocardiography, a non-invasive and widely available imaging technique, is commonly used to assess the structural and functional characteristics of the heart. In a recent study, researchers aimed to compare the echocardiographic characteristics and routine blood markers in healthy participants, including those who were positive for immunoglobulin G antibodies against severe acute respiratory syndrome-linked coronavirus (IgG-SARS).

Findings of the Study

The study revealed several important findings regarding the cardiovascular consequences of COVID-19 in healthy individuals. The left ventricular mass index (LVMI), a measure of the size and mass of the left ventricle, was found to be decreased in participants who tested positive for SARS antibodies.

Additionally, the E/A ratio, which assesses diastolic filling or left ventricular filling pressure, was lower in the SARS-positive group, indicating impaired early diastolic relaxation.

Another parameter, deceleration time (DT) of early mitral inflow, was found to be decreased in SARS-positive individuals. Shortened DT is associated with worse cardiovascular outcomes and increased stiffness of the left ventricular chamber. These findings suggest that COVID-19 may affect diastolic function and contribute to the development of cardiovascular complications.

Furthermore, the study examined the impact of COVID-19 on blood markers. Platelet count was slightly increased in SARS-positive participants, indicating a potential activation of platelets, which can contribute to thrombosis and coagulation abnormalities observed in COVID-19 patients.

The erythrocyte sedimentation rate (ESR), a marker of systemic inflammation, was also elevated in the SARS-positive group, suggesting persistent inflammation even in healthy individuals who had recovered from COVID-19.

Implications and Future Directions

The study highlights the need for further research to understand the long-term cardiovascular consequences of COVID-19 in healthy individuals. It is crucial to identify the mechanisms underlying these cardiac abnormalities and explore potential interventions to mitigate the risks associated with COVID-19 infection.

Conclusion

In conclusion, COVID-19 infection has significant implications for cardiovascular health, even in healthy individuals. The study discussed here revealed that COVID-19 can affect cardiac function, leading to changes in left ventricular mass, diastolic dysfunction, and alterations in blood markers related to thrombosis and inflammation.

These findings underscore the importance of monitoring cardiovascular health in individuals recovering from COVID-19 and provide a basis for future investigations into potential interventions and preventive measures. As the world continues to grapple with the ongoing COVID-19 pandemic, understanding the impact on cardiovascular health remains a critical area of research.


reference link : https://www.preprints.org/manuscript/202306.0473/v1

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