Publication date: Jul 13, 2025

Background: This study investigates the potential mechanisms behind changes in cardiac structure and function in long COVID patients. Methods: This study involved 176 consecutive outpatients in follow-up care (average age 55. 9 years; 58. 5% male) who experienced symptoms for over 12 weeks (average 6. 2 +/- 2. 7 months), following coronavirus infection (COVID-19). Results: The patients with long COVID and cardiovascular manifestations were significantly more hospitalized (88. 5% vs. 75. 9%) and had longer hospital stays. Significant echocardiography changes were observed in the left ventricular ejection fraction (LVEF) (59. 6 +/- 5. 4% vs. 62. 5 +/- 3. 8%); longitudinal strain (LS) in the sub-endocardium and intra-myocardium layers (-20. 9 vs. -22. 0% and -18. 6 vs. -19. 5%); circumferential strain (CS) in the sub-epicardium layers (-9. 6 vs. -10. 5%); and CS post-systolic shortening (CS PSS) (0. 138 vs. 0. 088 s). Additionally, pathological cardiac magnetic resonance (CMR) findings were seen in 58. 2% of the group of patients with long COVID and cardiovascular manifestation; 43. 3% exhibited positive late gadolinium enhancement (LGE), 21. 0% had elevated native T1 mapping, and 22. 4% had elevated native T2 mapping. Conclusions: Most patients with long COVID showed structural and functional changes in their cardiovascular systems, primarily caused by prolonged inflammation. Using multimodality imaging is important for uncovering the mechanisms to predict chronic myocarditis, early-stage heart failure, and pre-ischemic states, which can lead to serious complications. Recognizing the specific cardiovascular phenotypes associated with long COVID is essential in order to provide timely and appropriate treatment.

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