Long-Term Myocardial Involvement and Outcome in the Post-COVID-19 Condition

After SARS-CoV-2 infection, a subset of patients experience persistent cardiac symptoms, yet data on long-term cardiac involvement and clinical outcomes in the post-COVID-19 condition remain limited. This study aimed to investigate myocardial abnormalities using advanced cardiovascular magnetic resonance (CMR) imaging techniques in patients with ongoing cardiac symptoms for at least three months following COVID-19 diagnosis, and to assess their clinical outcomes. Between January 2021 and March 2022, 94 post-COVID-19 patients were examined at a median of 99 days (IQR 92–110) after diagnosis and compared to 100 controls. The CMR assessment included the left ventricular ejection fraction (LVEF), myocardial T2 signal, late gadolinium enhancement (LGE), and myocardial strain parameters. Follow-up for major adverse cardiac events (MACEs) was conducted at a median of 269 days (IQR 144–352). While no significant differences in LVEF were observed, post-COVID-19 patients demonstrated significantly reduced peak radial and circumferential strain values, suggesting subclinical myocardial dysfunction. Additionally, these patients exhibited a higher event rate compared to controls (0.063 vs. 0; p = 0.029). These findings indicate that patients with cardiac symptoms following COVID-19 may exhibit subtle but measurable myocardial changes and an increased risk of adverse outcomes. The observed alterations in myocardial strain most likely reflect mild, subclinical myocardial involvement within the spectrum of post-COVID-19 effects, rather than a direct cause of persistent symptoms. Further research is warranted to determine the prognostic significance of these findings.