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Doctors are competing to understand the building evidence that COVID-19 can damage the heart. Science

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In Genoa, Italy, a COVID-19 patient has recovered and is undergoing a cardiac function test.

Marco di Lauro / Stringer / GETTY IMAGES

Along Jennifer Kusan Frankel

ScienceThe COVID-19 report is supported by the Pulitzer Center and the Heising-Simons Foundation.

This fall, cardiologist Sammohidin will take on a new role in the research agenda. An MRI scan of his heart at St Bartholomew’s Hospital in London, where he works, helps answer pressing questions: as he was, as he was. COVID-Do people who suffer from mild or moderate seizures for 19 months need to worry about their hearts? health?

The fear that COVID-19 can cause heart inflammation called myocarditis is that the experience of COVID-19 is looking at people who were previously healthy caused by myocarditis-induced heart failure. As reported, it is called myocarditis. Mohidin recently treated 42-year-old Abul Kashem, who had typical COVID-19 symptoms in April. A month later, he became seriously ill with severe myocarditis. “I am grateful that I am alive,” says Kashem, who spent more than two weeks in the intensive care unit. Why did this happen? He wonders.

How the virus damages the heart muscle is just one of the questions researchers are currently investigating. Other studies track people during and after acute illness to determine the degree of general cardiac inflammation after COVID-19, the duration of COVID-19, and whether they respond to a particular treatment. I have. Researchers also want to know if patients respond in the same way as patients with myocarditis due to other causes. This includes chemotherapy and other viruses. In more than half of the cases caused by the virus, the inflammation resolves without problems.

However, in some cases it can lead to arrhythmias, impaired heart function, or, rarely, the need for a heart transplant. Now that millions of people are infected with the coronavirus, even a small percentage of people suffering from severe myocarditis will be many. “Will this be followed by more patients with heart failure?” Asks Peter Liu, a cardiologist and chief scientific officer at the University of Ottawa Heart Institute.

It is still unclear whether SARS-CoV-2, the virus that causes COVID-19, induces heart damage, including myocarditis, more frequently or more severely than other viruses. Survivors may be at increased risk of heart inflammation because SARS-CoV-2 can provoke a strong immune response throughout the body. Another idea suggests that COVID-19 patients are more susceptible to this condition because the virus invades the cells by binding to the angiotensin converting enzyme 2 (ACE2) receptor on cardiomyocytes. However, researchers are careful not to exceed the data. “This is a good hypothesis, but not tested,” says Leslie Cooper, a cardiologist at the Mayo Clinic in Jacksonville, Florida, about ACE2.

One of the reasons why it is difficult to say whether COVID-19 poses a special risk of myocarditis is the uncertainty about its prevalence after other infections. Echocardiography studies after the outbreak of some influenza suggest that up to 10% of influenza patients have transient heart abnormalities, Liu says. However, such research is inadequate. “We don’t scan after a patient has the flu,” says Valentina Püntmann, a cardiologist at the University of Frankfurt Hospital.

Just doing it to a patient with COVID-19 fueled concerns about myocarditis, Püntmann. Her team used MRI to scan the hearts of 100 COVID-19 patients. The scan showed cardiac abnormalities in 78 and 60 appeared to have active inflammation. Most also describe residual symptoms such as fatigue and mild shortness of breath, and suspect that it may be due to heart inflammation.

But Study by Püntmann and his colleaguesPublished in July JAMA CardiovascularPrompts an amazing headline, and many researchers say it needs to be duplicated. Cardiologists seek medical attention from people who have symptoms such as shortness of breath or chest discomfort after COVID-19, but are worried about the flood of healthy and recovered people seeking a heart assessment. Matthew Martinez, Head of Sports Cardiology at Morristown Medical Center, said:

Due to the physical demands of sports, team doctors need to be vigilant for myocarditis. paper JAMA Cardiovascular Last week, a study of 26 athletes from Ohio State University was reported after COVID-19. Four had developed myocarditis. Professional sports leagues are also scanning the minds of athletes infected with SARS-CoV-2. People with myocarditis, with or without symptoms, are benchmarked for fear that myocarditis can cause sudden death during intense activity. Martinez, who helps coordinate research with the National Basketball Association and Major League Soccer, predicts the flow of athlete data over the next few months. “Everyone of us in this space wants to ruin Saturday or Sunday to get this done.”

However, even if researchers can determine the average duration of myocarditis and the risk of young athletes, they can differ significantly in obese and hypertensive 50-year-old patients, especially if they are ill. Emphasize that. COVID-19 to be hospitalized. “In those individuals, I’ll be more cautious,” he says, screening for heart damage.

Others are looking for clues as to how COVID-19 can damage the heart. “SARS-CoV-2 challenges the immune system in a non-traditional way,” says Liu. Autopsy of heart tissue after COVID-19 revealed inflammation Blood vessels of the heart The site of inflammation caused by other infections instead of its muscle cells. Another autopsy study found Diffuse death of heart cellsHowever, the authors stated that the mechanism of injury is unknown. “There was a lot of debate about whether this was myocarditis,” says Liu. In any case, he and others want clinical trials to test whether preventive strategies, such as taking beta-blockers, can avoid heart failure in people flagged as high-risk after COVID-19. I’m out.

Mohidin volunteers to study survivors, and he is doing one of them. Aiming to recruit 140 people While in COVID-19 or shortly thereafter, 20 developed severe myocarditis and the rest did not. He and his colleagues look for abnormal T cell levels in the blood of people with myocarditis that help explain if and how the immune system causes heart damage. He is also investigating whether the immune cell pattern in blood-predicting myocarditis is later.

Even if COVID-19 rarely causes severe myocarditis, one hypothesis is that mild cases may increase the risk of heart disease after a few years. Scarring tissue can form when myocarditis heals, and previous studies have shown that residual heart inflammation can worsen heart health. As cardiologists, we’re in the business of identifying asymptomatic risk factors such as high blood pressure, Mohidin said. “In the future, it’s easy to imagine a clinician asking a new patient,’Did you have a COVID?’ “

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