Cardiovascular abnormalities of long-COVID syndrome: Pathogenic basis and potential strategy for treatment and rehabilitation

Abstract

Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome, i.e. post-acute sequelae of coronavirus disease 2019 (COVID-19) have emerged as a debilitating health burden that has posed challenges for management of pre-existing cardiovascular conditions and other associated chronic comorbidities in the most vulnerable group of patients recovered from acute COVID-19. A clear and evidence-based guideline for treating cardiac issues of long-COVID syndrome is still lacking. In this review, we have summarized the common cardiac symptoms reported in the months after acute COVID-19 illness and further evaluated the possible pathogenic factors underlying the pathophysiology process of long-COVID. The mechanistic understanding of how Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) damages the heart and vasculatures is critical in developing targeted therapy and preventive measures for limiting the viral attacks. Despite the currently available therapeutic interventions, a considerable portion of patients recovered from severe COVID-19 have reported a reduced functional reserve due to deconditioning. Therefore, a rigorous and comprehensive cardiac rehabilitation program with individualized exercise protocols would be instrumental for the patients with long-COVID to regain the physical fitness levels comparable to their pre-illness baseline.

Keywords

Long-COVID syndrome / Cardiac rehabilitation / Exercise intolerance / Inflammation / Hypoxia inducible factor 1 / SARS-CoV-2 tropism

Ethical approval statement

All studies included in this review were ensured to have obtained informed consent from each participant, and that the study was reviewed by the affiliated institution(s) and received approval to implement the study.

Conflict of interest

The authors have no conflicts of interest to disclose.

Authors’ contributions

JRS conceptualized and drafted the manuscript. EEK, MAS, and JLD critically reviewed the manuscript. JMD and PWG reviewed the manuscript. XW conceptualized and critically reviewed the manuscript.

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