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Summary: Long COVID is a global non-communicable epidemic characterized by long-lasting multiorgan symptoms after SARS-CoV-2 infection has subsided. This scientific document aims to provide insight into the cardiovascular manifestations of long COVID and the possible causes and therapeutic options available. Imaging has shown evidence of chronic perimyocarditis, arterial wall inflammation, and microthrombosis in certain patient populations. Understanding the underlying cellular and molecular mechanisms is crucial for the development of effective treatment strategies. However, current biomarkers are not highly predictive for the presence or outcome of long COVID.
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Alice G. Vassiliou et al.
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Summary: The prevailing hypotheses for the persistent symptoms of Long COVID have been narrowed down to immune dysregulation and autoantibodies, widespread organ damage, viral persistence, and fibrinaloid microclots (entrapping numerous inflammatory molecules) together with platelet hyperactivation. We demonstrate significantly increased concentrations of von Willebrand factor (VWF), platelet factor 4 (PF4), serum amyloid A (SAA), a-2 antiplasmin (a-2AP), endothelial-leukocyte adhesion molecule 1 (E-selectin), and platelet endothelial cell adhesion molecule (PECAM-1) in the soluble part of the blood. Presence of microclotting, together with relatively high levels of six biomarkers known to be key drivers of endothelial and clotting pathology, points to thrombotic endothelialitis as a key pathological process in Long COVID.
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Tushar Sood et al.
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Vikram Thakur et al.
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Infectious Diseases
Joan B. Soriano et al.
Summary: People with COVID-19 might experience long-term symptoms known as long COVID or long-haul COVID. The lack of a standardized definition hinders the understanding and treatment of this condition. In a WHO-led Delphi process, a consensus definition was developed, stating that post-COVID-19 condition occurs in individuals with a history of SARS-CoV-2 infection, with symptoms lasting for at least 2 months and impacting everyday functioning. This common framework provides a foundation for future studies and therapy.
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Diana A. Gorog et al.
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D. Castanares-Zapatero et al.
Summary: After almost 2 years of fighting against the SARS-CoV-2 pandemic, the number of patients experiencing persistent symptoms long after acute infection is concerning. This condition, known as long COVID or Post COVID-19 condition, has an unclear underlying pathophysiology. A comprehensive review was conducted to explore potential mechanisms for the persisting symptoms, such as organ damage, autonomic nervous system damage, immune dysregulation, auto-immunity, endothelial dysfunction, occult viral persistence, and coagulation activation.
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Cristian Cojocaru et al.
Summary: This study analyzed the clinical and epidemiological features of different variants of SARS-CoV-2 and made predictions about their potential future evolution. It hypothesized that the mutations were not due to vaccine pressure but rather depended on the natural characteristics of the virus. It is expected that SARS-CoV-2 will become more contagious but less deadly as it adapts to the human body.
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Ioannis Katsoularis et al.
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Ming Tong et al.
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Nihayet Bayraktar et al.
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Maitray A. Patel et al.
Summary: This study investigated vascular transformation biomarkers in patients with Long-COVID and found that these biomarkers were significantly elevated. Using machine learning, a unique two biomarker profile consisting of ANG-1/P-SEL was developed, providing a classification accuracy for Long-COVID status of 96%.
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Pawel Kozlowski et al.
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Respiratory System
Oriol Sibila et al.
Summary: The study found that about 60% of COVID-19 survivors had reduced DLCO 6 months after discharge, mainly in those over 60 years old, with a history of smoking, hypertension, severe COVID-19 experience, and persistent dyspnea after discharge. In addition, patients with reduced DLCO had higher levels of epithelial and endothelial markers.
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Alice G. Vassiliou et al.
Summary: The levels of eNOS were significantly lower in COVID-19-ARDS patients, while sACE2 levels were significantly higher. These results suggest the presence of two distinct defense mechanisms in COVID-19-derived ARDS, providing insights for therapeutic applications in COVID-19.
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Respiratory System
Thomas Sonnweber et al.
Summary: A study found that some COVID-19 patients still experienced persistent symptoms and lung function impairment 100 days after the onset of the disease, but there was significant improvement in symptoms and cardiopulmonary status over time.
EUROPEAN RESPIRATORY JOURNAL
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Respiratory System
Sabina A. Guler et al.
Summary: The Swiss COVID-19 lung study investigated pulmonary sequelae of COVID-19 in 113 survivors. Severe/critical COVID-19 was associated with significant functional and radiological abnormalities 4 months after infection, potentially due to small-airway and lung parenchymal disease. Systematic follow-up for survivors needs to be evaluated to optimize care for patients recovering from COVID-19.
EUROPEAN RESPIRATORY JOURNAL
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S. Van der Sar-van der Brugge et al.
Summary: This study conducted a long-term follow-up on survivors of non-critical COVID-19 pneumonia, revealing significant impairment in pulmonary function and quality of life six weeks after discharge, particularly in diffusion capacity.
RESPIRATORY MEDICINE
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Alice G. Vassiliou et al.
Summary: Endothelial damage markers were found to be significantly elevated in ICU non-survivors compared to survivors upon admission, suggesting their potential use in predicting mortality in COVID-19. The prognostic values of specific endothelial biomarkers were greater than 0.85 according to ROC analysis.
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Jose-Ramon Blanco et al.
Summary: This study aimed to describe lung function in patients recovering from COVID-19 hospitalization and to identify biomarkers in serum and induced sputum samples from these patients. A total of 100 patients with respiratory function tests were included in the study, with 47% of patients experiencing severe COVID-19 symptoms and 48% of patients having normal CT results.
CLINICAL MICROBIOLOGY AND INFECTION
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Critical Care Medicine
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Summary: The zoonotic SARS-CoV-2 virus causing COVID-19 has devastating consequences worldwide, affecting primarily the respiratory system but also leading to long-term complications. Understanding the pathophysiology and immune response of COVID-19 is crucial for optimizing patient care and treatment strategies.
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Jenneke Leentjens et al.
Summary: There is a high incidence of venous thromboembolism in COVID-19 patients, with treatment strategies varying based on patient severity and treatment stage. High-quality evidence on antithrombotic therapy in COVID-19 patients is emerging, with ongoing studies expected to provide further guidance for clinicians.
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Etheresia Pretorius et al.
Summary: Individuals with Long COVID/PASC may exhibit persistent symptoms due to the presence of persistent circulating plasma microclots that are resistant to fibrinolysis, including fatigue, shortness of breath, sleep issues, and anxiety or depression.
CARDIOVASCULAR DIABETOLOGY
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Chrysi Keskinidou et al.
Summary: Endothelial dysfunction, coagulation, and inflammation biomarkers are increasingly recognized as prognostic markers for poor outcomes and mortality in severe and critical COVID-19. Our study found that in critically ill COVID-19 patients, certain biomarkers such as sVCAM-1, suPAR, and presepsin can still be reliable prognostic indicators for ICU mortality even after dexamethasone administration. Patients with higher levels of sVCAM-1 or suPAR had a greater risk of mortality.
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Rainer Gloeckl et al.
Summary: The study demonstrates that pulmonary rehabilitation is a viable, safe, and effective therapeutic option for COVID-19 patients, regardless of disease severity. Patients showed improvements in exercise performance, lung function, and quality of life after rehabilitation.
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