Inflammation and cardiac injury markers were still high in COVID-19 patients five months after contracting the virus, a local study has shown.
Complaints of shortness of breath in COVID-positive patients months later were “not just in the mind”, the University of Malta research, carried out by Rachel Xuereb for her PhD also indicated.
Among the “interesting” findings, which have been accepted at an upcoming Barcelona congress of the European Society of Cardiology, COVID-19 positive patients had a higher white cell count than negative patients, which was indicative of infection and inflammation, said study supervisor and consultant cardiologist Caroline Magri.
They also show higher troponins – markers of heart damage – and lower levels of haemoglobin, indicating “something chronic is going on”, she said.
Besides a higher frequency of shortness of breath, fatigue, aches and pains and a worse score in general well-being, blood investigations showed a high marker of inflammation, known as high-sensitivity C-reactive protein, five months after contracting COVID-19, Magri explained.
“We believe this means the body can take time to get rid of the virus and, as yet, we do not know the long-term effects,” she continued.
“But we have found something to explain the shortness of breath – something is happening,” she said about the assessments of blood results, which have shown real physical ailments, including the ongoing process of infection and some cardiac muscle injury, to explain the symptom.
While the cardiac injury markers were there, they did decrease and improve but the long-term effect needed to be seen and follow-ups were required, the consultant insisted.
“We think that, with time, massive heart injury starts declining and, hopefully, there will be no residual effects.”
Studies on the related, but less impactful, SARS had determined more cases of atherosclerosis (narrowing and obstructions of the arteries) around five years later, for example.
'COVID-positive patients less fit'
Xuereb’s study, titled COVID-19 and Cardiovascular Outcomes, compared and assessed a cohort of 174 COVID-positive patients versus 75 people who did not contract the virus, in pre-vaccination days.
This comprised a random sample of the population, with a mean age of 46, with only nine per cent of the participants having been hospitalised due to COVID-19.
Assessments of their blood pressure and ECG monitoring over a 24-hour period also found a difference in heart rate variability between COVID-positive and negative respondents.
“The time variations between each heartbeat are indicative of some problem in the autonomic nervous system – the nerves that provide electricity to the arteries and heart – and mean the COVID-positive patients were less fit,” Magri explained.
“This is very interesting as there is very little data on it in terms of COVID -19. It is an innovative finding that could have major implications, resulting in worse outcomes, leading to increased mortality,” Magri continued.
“However, we need to see the long-term implications,” she stressed. “This five-month follow-up is just a taste and it is important that the cases and controls be assessed again in three years’ time as there could be more serious repercussions.
“This is what patients mean when they say they ‘never returned back to normal’,” Magro insisted.
The COVID clinic, set up within the Cardiology Department, was showing that these symptoms tended to improve but experience was still limited, Magri said.
The clinic was still receiving patients who were fully assessed after being referred due to post-COVID-19 symptoms. From first impressions, heart MRIs carried out showed the inflammation dwindled and, even though the patients were treated, this could also have resolved on its own.
“Some patients had been intubated in ITU and their initial echocardiogram was bad but they improved a lot and the planned escalation of treatment was not required,” Magri noted, insisting “we cannot generalise”.