Long COVID impact on myocardial reverse remodeling following aortic valve replacement

Abstract

Cardiovascular symptoms are among the most common manifestations of long COVID; yet its pathophysiological mechanisms remain poorly understood. Given the impact of long COVID on the cardiovascular system and its apparent link to impaired myocardial function, we hypothesized that it may affect myocardial plasticity in patients with heart valve disease, potentially altering post-surgical outcomes. This multicentric study investigated the effects of long COVID on myocardial reverse remodeling after aortic valve replacement (AVR) in patients with aortic stenosis. We recruited 96 participants who provided informed consent, collecting clinical, demographic, and echocardiographic data, before and after AVR, for each patient. Patients were stratified into three groups based on COVID-19 history prior to surgery: no infection, acute infection, and long COVID. Differences in echocardiographic parameters were analysed across groups and over time (pre- to post-procedure). Although preoperative echocardiographic profiles were comparable, significant regression of left ventricular hypertrophy was observed only in patients without prior SARS-CoV-2 infection. E/E', a marker of diastolic function, tended to ameliorate following surgery, although its reduction seemed to be greater among those with no infection, and even increased among long COVID patients. Similarly, post-AVR LVEF improvement was closer to significance among patients with no previous infection. These findings suggest that SARS-CoV-2 infection may impair myocardial recovery following AVR, negatively affecting both diastolic and systolic function, even among those who fully recovered from acute infection. While limited by sample size, this study underscores the need for objective criteria to identify persistent myocardial dysfunction post-COVID-19, irrespective of overt long COVID symptoms.