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"The findings could help to explain why some patients with long COVID still experience breathlessness one year later, and indicate that it might be linked to a decrease in heart performance," explained study author Dr. Maria-Luiza Luchian, of the University Hospital Brussels in Belgium.
Her team presented the findings Thursday at a virtual meeting of the European Society of Cardiology (ESC).
The new study included 66 patients, average age 50, who had no history of heart or lung disease before being hospitalized with COVID-19 between March and April 2020 at Luchian's hospital in Brussels.
One year after leaving the hospital, 35% of the patients still experienced shortness of breath during physical activity.
All of the patients underwent imaging of their lungs and heart, including a new imaging technique called "myocardial work," which provides more precise information on heart function than previous methods, the researchers said.
The results revealed poorer heart performance in people with shortness of breath compared to those without shortness of breath. There was also a significant and independent association between abnormal heart function and persistent shortness of breath ("dyspnea"), the study authors noted.
"Our study shows that more than a third of COVID-19 patients with no history of heart or lung disease had persistent dyspnea on effort a year after discharge from hospital," Luchian said in an ESC news release.
"When looking in detail at heart function by cardiac ultrasound, we observed subtle abnormalities that might explain the continued breathlessness," she noted.
"Future studies, including different COVID-19 variants and the impact of vaccination, are needed to confirm our results on the long-term evolution and possible cardiac consequences of this disease," Luchian suggested.
Two experts based in the United States said the new findings were interesting, but more study is needed.
Dr. Michael Goyfman is chief of cardiology at Long Island Jewish Forest Hills, in New York City. He said myocardial work is still largely unavailable in routine clinical practice, and "it remains unclear what treatments would be helpful for patients with shortness of breath a year after COVID who display these specific echocardiographic abnormalities. Additional studies would be helpful to apply these findings to patients."
Dr. Roshini Malaney is a cardiologist at Staten Island University Hospital, also in New York City. She explained that "shortness of breath is one of the most common symptoms of many heart conditions, such as a heart attack, heart failure and inflammation of the heart muscle, also known as myocarditis or pericarditis."
Malaney added that "COVID-19 is known to cause high amounts of inflammation in the body, which can accelerate or induce a heart condition that was not present before." Certain risk factors — smoking, high cholesterol, high blood pressure and diabetes — can raise a person's risk even further, she said.
"Persisting symptoms after an infection with COVID-19, especially shortness of breath, should warrant prompt evaluation by a cardiologist due to the possibility of underlying heart muscle damage from the infection," Malaney believes. Echocardiograms can help confirm a diagnosis.
"This is an easy, accessible and noninvasive test that can be done in the office, which gives us a lot of information about the heart and its function and can detect damage due to COVID-19," Malaney said.
Because the Belgian findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.
For more on long COVID, go to the U.S. Centers for Disease Control and Prevention.
SOURCES: Roshini Malaney, MD, cardiologist, Staten Island University Hospital, New York City; Michael Goyfman MD, chief of cardiology, Long Island Jewish Forest Hills, New York City; European Society of Cardiology, news release, Dec. 9, 2021
Ernie Mundell and Robert Preidt
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