Rationale for modifying the tactics of dispensary monitoring of the cardiovascular system in patients after COVID-19 infection

Objective: To identify clinical and instrumental characteristics of the cardiovascular system in COVID-19 convalescents, with the aim of optimizing follow-up monitoring strategies for this patient population.

Materials and Methods: The study enrolled 100 young and middle-aged patients at 6 months post-COVID-19 infection (44 severe cases, 56 moderate cases). Evaluations included: symptom assessment, physical examination, electrocardiography, and transthoracic echocardiography. Additionally, transthoracic echocardiography was performed in 20 randomly selected patients from this cohort at 12 months post-infection, along with 30 control subjects.

Results: Echocardiography revealed persistent, stable, and unidirectional parameter alterations in post-COVID patients compared to controls. The most significant findings involved diastolic dysfunction: a pseudonormal left ventricular dysfunction pattern was observed in 40% of patients at both 6- and 12-month follow-ups, while right ventricular dysfunction was present in 62% and 60% of patients, respectively. Pericardial effusion was detected in 50% of examined patients at both time points. Persistent pulmonary artery changes were documented: median diameters measured 27.5 mm (IQR 25.0–30.0) at 6 months and 28.0 mm (26.0–30.0) at 12 months for the main artery, with right branch diameters of 20.0 mm (18.0–22.0) and 19.0 mm (18.0–20.0), respectively. Pulmonary artery pressure remained higher than in the control group, with median values of 25.0 mmHg (17.0-28.0) at 6 months and 23.0 mmHg (18.0–25.0) at 12 months post-infection.

Conclusion: The study identified persistent cardiovascular sequelae in COVID-19 convalescents lasting ≥1 year, including biventricular diastolic dysfunction and pericardial effusion without evidence of regression. These findings support the need for modified clinical follow-up protocols for this patient population.

1. Tsampasian V., Bäck M., Bernardi M. et al. Cardiovascular disease as part of Long COVID: a systematic review // Eur. J. Prev. Cardiol. 2025. Vol. 32, № 6. P. 485-498. DOI: 10.1093/eurjpc/zwae070. PMID: 38381595.

2. Raman B., Bluemke D.A., Lüscher T.F. et al. Long COVID: Post-Acute Sequelae of COVID-19 with a Cardiovascular focus // Eur. Heart J. 2022. Vol. 43, № 11. P. 1157-1172. DOI: 10.1093/eurheartj/ehac031. PMID: 35176758.

3. Fernández-de-Las-Peñas C., Raveendran A.V., Giordano R. et al. Long COVID or Post-COVID-19 Condition: Past, Present and Future Research Directions // Microorganisms. 2023. Vol. 11, № 12: 2959. DOI: 10.3390/microorganisms11122959. PMID: 38138102.

4. Hayes L.D., Ingram J., Sculthorpe N.F. More Than 100 Persistent Symptoms of SARS-CoV-2 (Long COVID): A Scoping Review // Front. Med. (Lausanne). 2021. Vol. 8: 750378. DOI: 10.3389/fmed.2021.750378. PMID: 34790680.

5. Ramadan M.S., Bertolino L., Zampino R. et al. Cardiac Sequelae after Coronavirus Disease 2019 Recovery: a Systematic Review // Clin. Microbiol. Infect. 2021. Vol. 27, № 9. P. 1250-1261. DOI: 10.1016/j.cmi.2021.06.015. PMID: 34171458.

6. Mitchell C., Rahko P.S., Blauwet L.A. et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography // J. Am. Soc. Echocardiogr. 2019. Vol. 32, № 11. P. 1-64. DOI: 10.1016/j.echo.2018.06.004. PMID: 30282592.

7. Ageev F.T., Akchurin R.S., Buza V.V. i soavt. Rekomendatsii po dispansernomu nablyudeniyu bol’nykh s serdechno-sosudistymi zabolevaniyami // EKZh. 2015. № 1. S. 1-10.

8. Arutyunov G.P., Paleev F.N., Tarlovskaya E.I. i soavt. Perikardity. Klinicheskie rekomendatsii 2022 // Ros. kardiol. zhurn. 2023. T. 28, № 3. S. 5398. DOI: 10.15829/1560-4071-2023-5398.

9. O vnesenii izmeneniy v Programmu gosudarstvennykh garantiy besplatnogo okazaniya grazhdanam meditsinskoy pomoshchi na 2021 god i na planovyy period 2022 i 2023 godov: postanovlenie Pravitel’stva RF ot 18 iyunya 2021 g. № 927. URL: https://www.garant.ru/products/ipo/prime/doc/400814271/ (data obrashcheniya: 27.08.2024).