Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19

Ersin Sarıçam; Ali Doğan Dursun; Gülçin Türkmen Sarıyıldız; Nalan Can; Engin Bozkurt; Uğur Gönüllü; Nihal Basay; Meral Türkmen; Abdülaziz Denli; Mustafa Ünlü

doi:10.2147/IJGM.S321156

Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19

Int J Gen Med. 2021 Aug 29:14:4977-4985. doi: 10.2147/IJGM.S321156. eCollection 2021.

Authors

Ersin Sarıçam^{1

2}, Ali Doğan Dursun^{3

4}, Gülçin Türkmen Sarıyıldız^{5

6}, Nalan Can⁷, Engin Bozkurt¹, Uğur Gönüllü⁸, Nihal Basay⁹, Meral Türkmen¹⁰, Abdülaziz Denli¹¹, Mustafa Ünlü¹²

Affiliations

¹ Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.
² Department of Cardiology, Atılım University Medical School, Ankara, Turkey.
³ Department of Physiology, Atılım University Medical School, Ankara, Turkey.
⁴ Check-up Center, Home Care Services, Medicana International Ankara Hospital, Ankara, Turkey.
⁵ Department of General Surgery, Medicana International Ankara Hospital, Ankara, Turkey.
⁶ Operating Room Services, Vocational School of Health Services, Atılım University, Ankara, Turkey.
⁷ Department of Nuclear Medicine, Medicana International Ankara Hospital, Ankara, Turkey.
⁸ Department of Pulmonary Medicine, Atılım University Medical School, Ankara, Turkey.
⁹ Department of Pulmonary Medicine, Medicana International Ankara Hospital, Ankara, Turkey.
¹⁰ Department of Internal Medicine, Medicana International Ankara Hospital, Ankara, Turkey.
¹¹ Department of Physical Medicine and Rehabilitation, Medicana International Ankara Hospital, Ankara, Turkey.
¹² Department of Nuclear Medicine, Gazi University Medical School, Ankara, Turkey.

Abstract

Background: In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities.

Methods: In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)).

Results: The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30±35.15; 76.86±16.79, respectively; p < 0.001). Interestingly, the symptomatic patients had lower NO levels than asymptomatic patients (9.20±3.08; 16.15±6.02, respectively; p < 0.001). Echocardiography and CMR were normal. However, we found regional increased 18F-FDG uptake on cardiac PET to be compatible with myocardial fatigue.

Conclusion: We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.

Keywords: cardiac involvement; imaging; laboratory tests; post-acute COVID-19.

Grants and funding

This work was supported by Medicana International Ankara Hospital and Atilim University School of medicine. None of the funding sources had an influence on the design or production of the article.