Post-COVID-19 cardiac scarring and inflammation are common

  • JAMA Cardiol

  • Emily Willingham, PhD
  • Clinical Essentials
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  • Almost 8 in 10 patients who have “recovered” from COVID-19 have cardiac involvement on cardiac magnetic resonance imaging (CMR).
  • 60% showed signs of myocardial inflammation in this German cohort study.
  • Signs seen regardless of preexisting conditions, COVID-19 severity, or course.

Why this matters

  • Patients with a history of COVID-19 may need close cardiovascular follow-up.
  • Editorial notes findings in accompanying autopsy study, with evidence of the virus in the heart in 24/39 patients, along with evidence of viral replication.
  • Editorial: accumulating results “raise a new and very evident concern that cardiomyopathy and heart failure related to COVID-19 may potentially evolve as the natural history of this infection becomes clearer.”

Key results

  • Among 100 recovered patients (47% female; median age, 49 years; interquartile range, 45-53 years):
    • 33% had been hospitalized.
    • Only 1 had been treated with hydrochloroquine, which was discontinued.
  • At time of CMR, 17% had chest pain, 20% had palpitations, 36% had dyspnea.
  • 71% had detectable high-sensitivity troponin T, and 5% had significantly elevated values.
  • On CMR, 78% had abnormal cardiac findings.
  • Most informative CMR findings for COVID-19 cardiac pathology were increased native T1 and T2.

Study design

  • Prospective observational cohort study, University Hospital Frankfurt COVID-19 Registry, April-June 2020.
  • For some analyses, patients were age- and sex-matched to healthy volunteers (n=50) and risk-factor-matched patients (n=57).
  • Funding: German Ministry of Education and Research; others.


  • No pediatric patients.
  • No truly asymptomatic cases.
  • Outcomes pending.