Long-term sequelae of coronavirus disease: long COVID-19 and cardiovascular outcomes (a literature review)

Abstract

The COVID-19 pandemic has serious global implications for the healthcare system and economy. Although the recovery rate has increased significantly and the morbidity rate has decreased, long-term consequences, particularly cardiovascular, have come to the fore and become a global problem. As a result, in 2021, at the WHO level, the concept of “long-term COVID” was introduced, including more than 100 already described symptoms in patients for at least 3 months after initial recovery. At the same time, the clinical symptoms are not specific, strategies for the treatment of such disorders have not been worked out, and measures to detect and/or prevent the development of these complications have not been organized. The aim: to summarize the available data and modern views on the long-term cardiovascular effects of COVID-19, to reveal probable causes and risk factors for their development, as well as to analyze the presented information on the pathogenetic mechanisms of cardiovascular consequences after coronavirus disease. The literature data analysis has shown that SARS-CoV-2 viral persistence in the human body, reactivation of other viral agents, immune system dysregulation, autoimmunization development as well as the occurrence of microvascular thrombosis and endothelial dysfunction are among the pathogenetic mechanisms of long COVID. Although all these findings represent theoretical concepts regarding the pathogenesis of the long-term consequences of coronavirus disease, complementing and interacting with each other, at the moment, there is no formulated uniform explanation for the development of long-term effects of COVID-19. Also, large-scale studies point to the need for special attention to cardiovascular consequences of COVID-19. Among those already described in the literature are myocarditis, pericarditis, heart failure, arterial hypertension, arrhythmias, pulmonary embolism, cerebrovascular disorders, and cardiomyopathy. Given the prevalence of cardiovascular diseases and their impact on mortality, such processes have become a serious threat to the global healthcare system in the context of the COVID-19 pandemic. Conclusions. The available information on the causes and mechanisms of the long-term COVID development has been analyzed, and COVID-related cardiovascular disorders described in patients after recovery from acute coronavirus disease have been examined in detail. The study on this issue is extremely important since only by understanding the association between COVID-19 and cardiovascular diseases, studying pathogenetic mechanisms and identifying risk factors, it is possible to improve the prevention and treatment as well as to take control over cardiovascular consequences of COVID-19 at the global level.