In one study, published on July 27, 2020, in the Journal of the American Medical Association (JAMA), researchers analyzed cardiac magnetic resonance imaging scans (MRIs) of 100 patients ages 45 to 53 who had recently recovered from COVID-19. Most — around 70 percent — had recovered at home, without requiring hospitalization. According to Valentina Puntmann, MD, PhD, a clinical cardiologist at Goethe University Hospital in Frankfurt, Germany, who led the study, all 100 patients were relatively healthy, even the 60 who had preexisting cardiovascular disease. Despite this, more than two months after they recovered, nearly 80 percent of the survivors had structural changes to their hearts and 60 percent had inflammation that was independent of any preexisting conditions. The team also observed a biomarker typically found after a heart attack, which indicates cardiac injury, in more than 75 percent of the patients. They also found scar tissue, and rare instances of impaired pump function. “We kept our expectations low because we could not scan patients while they were still infected, and the findings were a huge surprise for everyone. There was a huge burden of inflammation after recovery,” said Dr. Puntmann, who noted that inflammation is a common occurrence when a person is actively fighting off a virus. Yet it’s unclear why 60 percent of patients still had heart inflammation even after recovery. “The heart muscle is inflamed and somehow cannot curb it, which is something we call an autoimmune reaction. Other than that, we are pretty much in the dark as to whether or not this is something that will be permanent or if people can recover from it,” she says, noting that if inflammation does persist, it could eventually lead to heart failure. Another more recent study, also by German researchers and published on July 27, 2020, in JAMA, included autopsy reports from 39 people ages 78 to 89 years who died of COVID-19. The researchers found high amounts of the novel coronavirus in the hearts of more than 60 percent of the autopsy reports. The team noted that this could be due to higher viral loads in some patients and not others, and called for more research into the long-term cardiovascular impacts of the virus. According to Khadijah Breathett, MD, an assistant professor of cardiology at the University of Arizona in Tucson, both studies were relatively small — which is typical for studies related to COVID-19 — and both were conducted from one specific area, which may have less racial and socioeconomic diversity than elsewhere in the world. She says that these factors make it difficult to say whether or not the findings will apply evenly to other communities. For some communities, the outcomes may be worse. “When you consider the different proportions of cardiovascular disease among different socioeconomic populations, the risk for cardiovascular disease, and likely cardiac inflammation, could be higher in different populations,” says Dr. Breathett. For example, cardiovascular disease (CVD), including stroke and heart attack, disproportionately impacts Black Americans. According to the Centers for Disease Control and Prevention (CDC), African Americans ages 18 to 49 are twice as likely to die from heart disease as white Americans. Still, Breathett says studies like these provide key clues that help doctors better understand how COVID-19 impacts the body. “These studies were very important ones to help understand how the inflammatory process affects the heart post-COVID-19 infection,” says Breathett. “To date, it’s been rather unclear whether or not myocarditis — inflammation of the heart muscle — occurs after COVID-19. What remains to be seen is the long-term impact of the virus. Only time will tell whether or not these patients are at higher risk for heart failure or increased clotting.” RELATED: What People With Heart Disease Need to Know About COVID-19 “We know how to prevent getting COVID-19, but we don’t know how to prevent inflammation in the heart and we don’t know what the proper treatments for it are. We’re learning as we go and the public has to give us some time to develop the evidence and data to tell them what is best to reduce their risk for cardiovascular events if they develop COVID-19,” says Breathett. “Hopefully over the next couple of years, we will know which are the appropriate medications that should be given to these populations to prevent future complications.” In the meantime, Breathett says she’s most shocked by the number of people she observes who are not taking the potential ramifications of the virus seriously. “The common mantra is that we’re all in this together, but it will take everyone’s effort. It’s the asymptomatic individuals who are likely playing a large role in the spread of the disease,” she says.
