Anticipating the long-term cardiovascular effects of COVID-19
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EDITORIAL
Anticipating the long‑term cardiovascular effects of COVID‑19 Richard C. Becker1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Introduction SARS-CoV2 infection can impact all organs structurally and functionally. Persisting symptoms in patients recovering from coronavirus disease 2019 (COVID-19) are common and with close follow-up can be detected in nearly 90% of patients 60 days from the original diagnosis [1]. The most common symptoms are fatigue, dyspnea, joint pain, chest pain, cough, insomnia and headache. Given the well-documented involvement of the circulatory system in COVID-19, including small, moderate and large-sized veins and arteries, coupled with robust immune and resulting local and systemic inflammatory responses, one would anticipate a prolonged recovery period and potentially longterm cardiovascular effects. The following editorial review summarizes the pathogenesis of structural, functional and metabolic abnormalities associated with COVID-19 and postulates long-term cardiovascular effects and management strategies under a broad clinical umbrella referred to as postCOVID-19 syndrome.
Acute stages of COVID‑19: setting the stage for prolonged clinical effects The frequency of cardiac injury, vascular dysfunction and thrombosis in patients with COVID-19, including those persons with either no or minimal symptoms during their initial infection, raises important questions about potential longterm cardiovascular effects: these could include heart failure, life-threatening arrhythmias, sudden cardiac death, impaired myocardial flow reserve from microvascular injury, coronary artery and aorta aneurysm formation, hypertension, labile * Richard C. Becker [email protected] 1
Department of Medicine, University of Cincinnati Heart and Circulation Research Institute, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
heart rate and blood pressure responses to activity, accelerated atherosclerosis and both venous and arterial thromboembolic disease [2]. Indeed, events during the acute phase of disease, including those that are clinically unsuspected and undiagnosed [3] will increase the risk for recurring events [4–6]. How will the medical community follow patients with COVID-19? How will future events be prevented? The COVID-19 pandemic and its reporting has focused primarily on two areas—the number of cases and the number of deaths. Both statistics are of great importance, yet neither sufficiently captures an equally important metric of morbidity that is responsible for resource utilization, assessment of vulnerable populations, cost, recovery, long-term health effects, and quality of life [7]. A morbidity index of COVID-19 survivors is particularly relevant when considering co-morbid factors and traits for SARS-CoV-2 infection susceptibility, need for hospitalization, level of care and their collective impact on the severity of illness [8]. Indeed, selfreported data from the 2018 Behavioral Risk Factor Surveillance Syste
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