Schellenberg J; Sports and Rehabilitation Medicine, University Hospital Ulm, Germany.
Matits L; Bizjak DA; Deibert P; et al;

Infection. 53(5):1685-1697, 2025 Oct. VI 1

SARS-CoV-2 infection has been predominantly reported in hospitalized
patients, but long-term cardiac sequelae in large, well-characterized
cohorts remain inconclusive. This study evaluated cardiac structure and
function in individuals with post-Coronavirus disease (COVID) syndrome
(PCS) compared to recovered controls (CON), focusing on associations with
cardiopulmonary symptoms and rapid physical exhaustion (RPE).

METHODS: This multicenter, population-based study included 1154
participants (679 PCS, 475 age- and sex matched CON; mean age 49 +/- 12
years; 760 women) 1.5 years post-infection. Transthoracic echocardiography
assessed LV global longitudinal strain (GLS), RV GLS and RV free wall
strain (FWS), and other measures. Cardiopulmonary exercise testing (CPET)
measured maximum respiratory oxygen uptake (VO2max) as a marker of
cardiopulmonary fitness.

RESULTS: PCS participants exhibited significantly lower LV GLS (-20.25%
[-21.28 – -19.22] vs. -20.73% [-21.74 – -19.72], p = 0.003), reduced
diastolic function (E/A 1.16 [1.04-1.27] vs. 1.21 [1.1-1.32], p = 0.022)
and decreased TAPSE (24.45 mm [22.14-26.77] vs. 25.05 mm [22.78-27.32], p
= 0.022) compared to CON, even after adjusting for confounders. RV strain
values were similar between groups. LV GLS correlated inversely with
VO2max (p = 0.004) and positively with RPE (p = 0.050), though no
associations were observed with other cardiopulmonary symptoms.

CONCLUSIONS: This study demonstrates subtle yet consistent reductions in
LV function, specifically LV GLS and diastolic function, and exercise
capacity in PCS compared to CON. While these changes are within reference
ranges, their potential impact on clinical outcomes warrants further
investigation. These findings highlight the need for cardiac assessments
and long-term follow-up in symptomatic PCS patients.