SynthesisAnnals of cardiac anaesthesia2026
Cardiac Effects in Post-COVID-19 Heart Failure: A Systematic Review of Longitudinal Imaging- and Biomarker-Based Structural and Functional Remodeling.
Synthesis in Annals of cardiac anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
abstractCOVID-19 has been linked to persistent cardiovascular sequelae, yet the trajectory of structural and functional cardiac changes beyond the acute phase remains unclear. This systematic review synthesizes longitudinal evidence on post-COVID cardiac remodeling assessed by imaging and biomarkers. Following PRISMA guidelines, we searched PubMed and Cochrane Library (January 2020-April 2025) for peer-reviewed studies enrolling adults (≥18 years) with polymerase chain reaction (PCR)/antigen-confirmed SARS-CoV-2 infection and reporting cardiac outcomes ≥ 12 weeks post-infection. Eligible outcomes included imaging-based abnormalities (cardiac magnetic resonance [CMR]: T1/T2 mapping, late gadolinium enhancement [LGE]; echocardiography: left ventricular ejection fraction [LVEF], LV/RV strain). Longitudinal trends of biomarkers (troponin, NT-proBNP, C-reactive protein [CRP]) were also studied. Risk of bias was assessed using joanna briggs institute (JBI) tools; synthesis followed synthesis without metaanalysis (SWiM) principles. Fifteen studies (n ≈ 166,000; 14 cohorts, 1 case report) were included. Across CMR cohorts, global systolic function was largely preserved, but tissue abnormalities were frequent early and improved over time: edema indices normalized by ~ 12 months, while LGE prevalence declined (e.g. 50%→19% in paired scans). However, residual non-ischemic scars and elevated T1/T2 persisted in symptomatic subgroups. Echocardiography showed normal LVEF, but subtle left ventricular global longitudinal strain (LV-GLS) impairment versus controls (e.g. -18.5% vs - 19.3%). Biomarker trends were heterogeneous: natriuretic peptide positivity persisted in patients with prior cardiovascular disease (CVD), while troponin and CRP generally normalized. Large population-based cohorts demonstrated sustained 12-month risk for heart failure, myocarditis, and major cardiovascular events, graded by acute severity. Most patients recover gross systolic function, yet subclinical myocardial changes and elevated population-level cardiovascular risk persist up to 1 year. These findings support risk-stratified follow-up, judicious use of advanced imaging, and preventive cardiology strategies.
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