{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:01:45Z","timestamp":1785402105838,"version":"3.56.0"},"reference-count":41,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Timi\u0219oara, Romania"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Cardiovascular involvement is among the most consequential sequelae of SARS-CoV-2 infection. Myocardial injury, arrhythmia, and thromboembolic disease have been characterized in depth, yet the relationship between COVID-19 and valvular heart disease (VHD), and its interplay with heart failure (HF), has received comparatively limited synthesis. This narrative review consolidates current evidence on the mechanisms, diagnosis, differential assessment, and clinical outcomes linking acute and post-acute COVID-19 to valvular dysfunction and to incident or worsening heart failure, with emphasis on practical implications for cardiologists and internists. Methods: We searched PubMed, Scopus, and Web of Science (January 2020\u2013January 2026) for studies on valvular dysfunction, heart failure, myocardial injury, and endothelial pathology in SARS-CoV-2 infection, and synthesized findings narratively. Results: Convergent pathways\u2014endothelial injury, systemic hyperinflammation, micro- and macrovascular thrombosis, and pressure\u2013volume overload\u2014contribute to functional and, less frequently, structural valvular changes. Available evidence suggests that clinically relevant post-COVID valvular abnormalities are more often secondary\/functional (mitral and tricuspid regurgitation) than primary structural lesions, although dedicated prospective valvular studies remain scarce. Pre-existing severe VHD markedly worsens acute COVID-19 prognosis. Elevated NT-proBNP, troponin, and interleukin-6 consistently predict decompensation and mortality, and a substantial minority of survivors show persistent fibrotic pulmonary changes and restrictive ventilatory defects on follow-up (pulmonary rather than cardiac findings). Conclusions: Post-COVID valvular dysfunction appears, on currently available but largely indirect evidence, predominantly functional and inflammation-related, and may overlap with HFpEF phenotypes in selected patients when objective diagnostic criteria are fulfilled. Biomarker-guided, multimodality follow-up is reasonable in high-risk survivors, and prospective longitudinal studies with standardized valvular endpoints remain a priority. Dedicated longitudinal evidence on valvular outcomes specifically remains very limited.<\/jats:p>","DOI":"10.3390\/jcm15135007","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T08:45:20Z","timestamp":1782722720000},"page":"5007","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Valvular Heart Disease and Heart Failure in the Post-COVID-19 Era: A Narrative Review of Mechanisms, Diagnosis, Differential Assessment, and Clinical Outcomes"],"prefix":"10.3390","volume":"15","author":[{"given":"Maria","family":"Rada","sequence":"first","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iasmina Madalina","family":"Petculescu","sequence":"additional","affiliation":[{"name":"Department of Materials and Fabrication Engineering, Politehnica University Timisoara, Boulevard Mihai Viteazu, Number 1, 300222 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6025-5998","authenticated-orcid":false,"given":"Ana-Maria","family":"Pah","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7868-9266","authenticated-orcid":false,"given":"Adina","family":"Avram","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu, Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana Emilia","family":"Velimirovici","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3703-6392","authenticated-orcid":false,"given":"Ariana Bianca","family":"Velciov","sequence":"additional","affiliation":[{"name":"Food Science Department, University of Life Sciences \u201cKing Michael I\u201d Timisoara, Calea Aradului, 300645 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7351-741X","authenticated-orcid":false,"given":"Cristina","family":"Tudoran","sequence":"additional","affiliation":[{"name":"Department VII, Internal Medicine II, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square, Number 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3536-6099","authenticated-orcid":false,"given":"Stela","family":"Iurciuc","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7708-7314","authenticated-orcid":false,"given":"Diana","family":"Utu","sequence":"additional","affiliation":[{"name":"Department II, Physiology and Pathophysiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6325-185X","authenticated-orcid":false,"given":"Dan Radu","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Department of Surgery I, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Laura","family":"Craciun","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.kint.2020.04.003","article-title":"Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China","volume":"98","author":"Su","year":"2020","journal-title":"Kidney Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1001\/jamacardio.2020.0950","article-title":"Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China","volume":"5","author":"Shi","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1001\/jamacardio.2020.1105","article-title":"Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality","volume":"5","author":"Bonow","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1093\/eurheartj\/ehac031","article-title":"Long COVID: Post-acute sequelae of COVID-19 with a cardiovascular focus","volume":"43","author":"Raman","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1093\/cvr\/cvaa106","article-title":"COVID-19 and the cardiovascular system: Implications for risk assessment, diagnosis, and treatment options","volume":"116","author":"Guzik","year":"2020","journal-title":"Cardiovasc. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jacc.2013.02.092","article-title":"A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation","volume":"62","author":"Paulus","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s11897-021-00509-y","article-title":"Myocardial involvement in COVID-19: An interaction between comorbidities and heart failure with preserved ejection fraction. A further indication of the role of inflammation","volume":"18","author":"Zaccone","year":"2021","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1080\/24748706.2021.1908646","article-title":"Severe valvular heart disease and COVID-19: Results from the Multicenter International Valve Disease Registry","volume":"5","author":"Dvir","year":"2021","journal-title":"Struct. Heart"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.amjms.2022.02.005","article-title":"A clinical profile of infective endocarditis in patients with recent COVID-19: A systematic review","volume":"364","author":"Hindy","year":"2022","journal-title":"Am. J. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1093\/ehjci\/jeaa178","article-title":"Global evaluation of echocardiography in patients with COVID-19","volume":"21","author":"Dweck","year":"2020","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mateescu, D.-M., Ilie, A.-C., Cotet, I., Guse, C., Muresan, C.-O., Pah, A.-M., Badalica-Petrescu, M., Iurciuc, S., Craciun, M.-L., and Avram, A. (2025). Pulmonary embolism in hospitalized COVID-19 patients in Romania: Prevalence, risk factors, outcomes. Viruses, 17.","DOI":"10.3390\/v17101342"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mateescu, D.-M., Gavrilescu, D.-M., Marginean, A., Cotet, I.-G., Guse, E.-C., Muresan, C.-O., Toma, A.-O., Iurciuc, S., Ilie, A.-C., and Enache, A. (2025). Acute pulmonary edema in COVID-19: Clinical predictors, long-term pulmonary sequelae, and mortality in a Romanian cohort study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14228188"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mateescu, D.-M., Ilie, A.-C., Cotet, I., Muresan, C.-O., Pah, A.-M., Badalica-Petrescu, M., Iurciuc, S., Craciun, M.-L., Cote, A., and Enache, A. (2025). Predicting COVID-19 sepsis outcomes: Roles of IL-6, cardiac biomarkers, clinical factors, and vaccination status and exploratory analysis of tocilizumab therapy in an Eastern European cohort. Viruses, 17.","DOI":"10.20944\/preprints202507.2097.v1"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Mateescu, D.-M., Toma, A.-O., Gavrilescu, D.-M., Ilie, A.-C., Florescu, E., Rosca, O., Oancea, C., Iurciuc, S., Muresan, C.-O., and Enache, A. (2026). Patterns of antibiotic use in hospitalized COVID-19 patients and association with secondary infections and outcomes. Antibiotics, 15.","DOI":"10.3390\/antibiotics15030240"},{"key":"ref_17","first-page":"e2022030","article-title":"Infective endocarditis and COVID-19 coinfection: An updated review","volume":"93","author":"George","year":"2022","journal-title":"Acta Biomed."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1001\/jamacardio.2020.3557","article-title":"Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19)","volume":"5","author":"Puntmann","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1136\/heartjnl-2024-324316","article-title":"Longitudinal cardiac imaging for assessment of myocardial injury in non-hospitalised community-dwelling individuals after COVID-19 infection: The Rotterdam Study","volume":"111","author":"Aribas","year":"2025","journal-title":"Heart"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1001\/jamacardio.2020.3551","article-title":"Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases","volume":"5","author":"Lindner","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sritharan, H.P., Bhatia, K.S., van Gaal, W., Kritharides, L., Chow, C.K., and Bhindi, R. (2023). Association between pre-existing cardiovascular disease, mortality and cardiovascular outcomes in hospitalised patients with COVID-19. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1224886"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Russo, G., Maisano, F., Massaro, G., Terlizzese, G., Mariano, E., Bonanni, M., Matteucci, A., Bezzeccheri, A., Benedetto, D., and Chiricolo, G. (2022). Challenges and Open Issues in Transcatheter Mitral Valve Implantation: Smooth Seas Do Not Make Skillful Sailors. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.738756"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Karakasis, P., Nasoufidou, A., Sagris, M., Fragakis, N., and Tsioufis, K. (2024). Vascular Alterations Following COVID-19 Infection: A Comprehensive Literature Review. Life, 14.","DOI":"10.3390\/life14050545"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Pamporis, K., Karakasis, P., Pantelidaki, A., Goutis, P.A., Grigoriou, K., Theofilis, P., Katsaouni, A., Botis, M., Karanikola, A.-E., and Milaras, N. (2025). Sepsis-Induced Cardiomyopathy and Cardiac Arrhythmias: Pathophysiology and Implications for Novel Therapeutic Approaches. Biomedicines, 13.","DOI":"10.3390\/biomedicines13112643"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e005332","DOI":"10.1161\/CIRCIMAGING.116.005332","article-title":"State-of-the-art review of echocardiographic imaging in the evaluation and treatment of functional tricuspid regurgitation","volume":"9","author":"Hahn","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.jacc.2020.06.068","article-title":"Cardiac troponin for assessment of myocardial injury in COVID-19","volume":"76","author":"Sandoval","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.jacc.2022.02.003","article-title":"2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play","volume":"79","author":"Gluckman","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","unstructured":"Vassiliou, V.S., Tsampasian, V., Luchian, M.L., D\u2019Ascenzi, F., D\u2019Ascenzo, F., Dweck, M.R., Escaned, J., Gati, S., Halle, M., and Koskinas, K.C. (2025). Cardiovascular disease prevention and management in COVID-19: A clinical consensus statement of the EAPC, EACVI, ACNAP, EAPCI, and HFA of the ESC. Eur. J. Prev. Cardiol., zwaf540."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for noninvasive evaluation of native valvular regurgitation","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10554-020-01968-5","article-title":"Evaluation of biventricular function in patients with COVID-19 using speckle-tracking strain echocardiography","volume":"37","author":"Baycan","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1016\/j.jcmg.2021.04.011","article-title":"Prospective case-control study of cardiovascular abnormalities 6 months following mild COVID-19 in healthcare workers","volume":"14","author":"Joy","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1093\/eurheartj\/ehab075","article-title":"Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance","volume":"42","author":"Kotecha","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Zhang, T., Li, Z., Mei, Q., Walline, J.H., Zhang, Z., Liu, Y., Zhu, H., and Du, B. (2025). Cardiovascular outcomes in long COVID-19: A systematic review and meta-analysis. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1450470"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1038\/s41467-024-46497-0","article-title":"Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study","volume":"15","author":"Cezard","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Matteucci, A., Bonanni, M., Centioni, M., Zanin, F., Geuna, F., Massaro, G., and Sangiorgi, G. (2021). Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081618"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e002787","DOI":"10.1136\/openhrt-2024-002787","article-title":"Appropriate use of wearable defibrillators with multiparametric evaluation to avoid unnecessary defibrillator implantation","volume":"11","author":"Matteucci","year":"2024","journal-title":"Open Heart"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Italia, L., Tomasoni, D., Bisegna, S., Pancaldi, E., Stretti, L., Adamo, M., and Metra, M. (2021). COVID-19 and heart failure: From epidemiology during the pandemic to myocardial injury, myocarditis, and heart failure sequelae. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.713560"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5007\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:27:52Z","timestamp":1783070872000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":41,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135007"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135007","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}