{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:34:07Z","timestamp":1786649647919,"version":"build-2736575974"},"reference-count":63,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>COVID-19 has been linked to persistent cardiovascular sequelae, yet the trajectory of structural and functional cardiac changes beyond the acute phase remains unclear. This systematic review synthesizes longitudinal evidence on post-COVID cardiac remodeling assessed by imaging and biomarkers. Following PRISMA guidelines, we searched PubMed and Cochrane Library (January 2020\u2013April 2025) for peer-reviewed studies enrolling adults (\u226518 years) with polymerase chain reaction (PCR)\/antigen-confirmed SARS-CoV-2 infection and reporting cardiac outcomes \u2265 12 weeks post-infection. Eligible outcomes included imaging-based abnormalities (cardiac magnetic resonance [CMR]: T1\/T2 mapping, late gadolinium enhancement [LGE]; echocardiography: left ventricular ejection fraction [LVEF], LV\/RV strain). Longitudinal trends of biomarkers (troponin, NT-proBNP, C-reactive protein [CRP]) were also studied. Risk of bias was assessed using joanna briggs institute (JBI) tools; synthesis followed synthesis without metaanalysis (SWiM) principles. Fifteen studies (n \u2248 166,000; 14 cohorts, 1 case report) were included. Across CMR cohorts, global systolic function was largely preserved, but tissue abnormalities were frequent early and improved over time: edema indices normalized by ~ 12 months, while LGE prevalence declined (e.g. 50%\u219219% in paired scans). However, residual non-ischemic scars and elevated T1\/T2 persisted in symptomatic subgroups. Echocardiography showed normal LVEF, but subtle left ventricular global longitudinal strain (LV-GLS) impairment versus controls (e.g. \u221218.5% vs \u2212 19.3%). Biomarker trends were heterogeneous: natriuretic peptide positivity persisted in patients with prior cardiovascular disease (CVD), while troponin and CRP generally normalized. Large population-based cohorts demonstrated sustained 12-month risk for heart failure, myocarditis, and major cardiovascular events, graded by acute severity. Most patients recover gross systolic function, yet subclinical myocardial changes and elevated population-level cardiovascular risk persist up to 1 year. These findings support risk-stratified follow-up, judicious use of advanced imaging, and preventive cardiology strategies.<\/jats:p>","DOI":"10.4103\/aca.aca_214_25","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:00:12Z","timestamp":1776171612000},"page":"157-168","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Effects in Post\u2013COVID-19 Heart Failure: A Systematic Review of Longitudinal Imaging- and Biomarker-Based Structural and Functional Remodeling"],"prefix":"10.4103","volume":"29","author":[{"given":"Syed","family":"Abid","sequence":"first","affiliation":[{"name":"General Medicine, Lister Hospital, Steveange, England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humaira","family":"Jannath","sequence":"additional","affiliation":[{"name":"General Medicine, Lister Hospital, Steveange, England"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260415","doi-asserted-by":"crossref","first-page":"e00344","DOI":"10.1128\/mSphere.00344-20","article-title":"COVID-19: An immunopathological view","volume":"5","author":"Kadkhoda","year":"2020","journal-title":"mSphere"},{"key":"R2-20260415","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"N Engl J Med"},{"key":"R3-20260415","article-title":"COVID-19 Epidemiological Update","year":"2024"},{"key":"R4-20260415","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"R5-20260415","doi-asserted-by":"crossref","first-page":"4669","DOI":"10.1021\/acs.jpcb.2c01048","article-title":"SARS-CoV-2 Omicron variant binds to human cells more strongly than the wild type: Evidence from molecular dynamics simulation","volume":"126","author":"Nguyen","year":"2022","journal-title":"J Phys Chem B"},{"key":"R6-20260415","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"R7-20260415","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.coviro.2021.08.010","article-title":"Structure of SARS-CoV-2 spike protein","volume":"50","author":"Zhang","year":"2021","journal-title":"Curr Opin Virol"},{"key":"R8-20260415","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s43440-021-00303-6","article-title":"Understanding the role of ACE-2 receptor in pathogenesis of COVID-19 disease: A potential approach for therapeutic intervention","volume":"73","author":"Shirbhate","year":"2021","journal-title":"Pharmacol Rep"},{"key":"R9-20260415","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.cell.2020.02.058","article-title":"Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein","volume":"181","author":"Walls","year":"2020","journal-title":"Cell"},{"key":"R10-20260415","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1038\/s41569-020-0413-9","article-title":"COVID-19 and cardiovascular disease: From basic mechanisms to clinical perspectives","volume":"17","author":"Nishiga","year":"2020","journal-title":"Nat Rev Cardiol"},{"key":"R11-20260415","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1161\/CIRCULATIONAHA.120.046941","article-title":"COVID-19 and cardiovascular disease","volume":"141","author":"Clerkin","year":"2020","journal-title":"Circulation"},{"key":"R12-20260415","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1001\/jamacardio.2020.1286","article-title":"Potential effects of coronaviruses on the cardiovascular system","volume":"5","author":"Madjid","year":"2020","journal-title":"JAMA Cardiol"},{"key":"R13-20260415","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":"R14-20260415","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus\u2013infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"R15-20260415","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":"R16-20260415","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.thromres.2020.04.013","article-title":"Incidence of thrombotic complications in critically ill ICU patients with COVID-19","volume":"191","author":"Klok","year":"2020","journal-title":"Thromb Res"},{"key":"R17-20260415","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1161\/CIRCULATIONAHA.120.047971","article-title":"Spectrum of cardiac manifestations in COVID-19","volume":"142","author":"Szekely","year":"2020","journal-title":"Circulation"},{"key":"R18-20260415","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":"R19-20260415","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1093\/ehjci\/jeab006","article-title":"Influence of aneurysmal aortic root geometry on mechanical stress to the aortic valve leaflet","volume":"22","author":"Hayashi","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"R20-20260415","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jacc.2020.06.007","article-title":"Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection","volume":"76","author":"Lala","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"R21-20260415","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1161\/01.CIR.0000093381.57779.67","article-title":"C-Reactive protein","volume":"108","author":"Ridker","year":"2003","journal-title":"Circulation"},{"key":"R22-20260415","first-page":"310","article-title":"Cardiovascular biomarkers in patients with COVID-19","volume":"10","author":"Mueller","year":"2021","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"R23-20260415","doi-asserted-by":"crossref","first-page":"690790","DOI":"10.3389\/fcvm.2021.690790","article-title":"B-type natriuretic peptide concentrations, COVID-19 severity, and mortality: A systematic review and meta-analysis with meta-regression","volume":"8","author":"Zinellu","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"R24-20260415","doi-asserted-by":"crossref","first-page":"389","DOI":"10.31083\/j.rcm2312389","article-title":"Cardiac magnetic resonance imaging of COVID-19-associated cardiac sequelae: A systematic review","volume":"23","author":"Boparai","year":"2022","journal-title":"Rev Cardiovasc Med"},{"key":"R25-20260415","article-title":"Long-term cardiac symptoms following COVID-19: A systematic review and meta-analysis","author":"Guo","year":"2023","journal-title":"medRxiv"},{"key":"R26-20260415","doi-asserted-by":"crossref","first-page":"817","DOI":"10.3390\/jcm14030817","article-title":"Interrelationships between plasma levels of brain natriuretic peptide and prolonged symptoms due to long COVID","volume":"14","author":"Masuda","year":"2025","journal-title":"J Clin Med"},{"key":"R29-20260415","doi-asserted-by":"crossref","first-page":"101484","DOI":"10.1016\/j.cegh.2023.101484","article-title":"Introduction to the GRADE tool for rating certainty in evidence and recommendations","volume":"25","author":"Prasad","year":"2024","journal-title":"Clin Epidemiol Glob Health"},{"key":"R30-20260415","first-page":"1","article-title":"Cardiac abnormalities in long COVID 1-year post-SARS-CoV-2 infection","volume":"10","author":"Fernandez","year":"2023","journal-title":"Open Heart"},{"key":"R31-20260415","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1038\/s41591-022-02000-0","article-title":"Long-term cardiac pathology in individuals with mild initial COVID-19 illness","volume":"28","author":"Puntmann","year":"2022","journal-title":"Nat Med"},{"key":"R32-20260415","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1093\/cvr\/cvac195","article-title":"Association of COVID-19 with short- and long-term risk of cardiovascular disease and mortality: A prospective cohort in UK Biobank","volume":"119","author":"Wan","year":"2023","journal-title":"Cardiovasc Res"},{"key":"R33-20260415","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/openhrt-2024-002662","article-title":"Long COVID and cardiovascular disease: A prospective cohort study","volume":"11","author":"Lawson","year":"2024","journal-title":"Open Heart"},{"key":"R34-20260415","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/cpf.12909","article-title":"COVID-19 is associated with cardiac structural and functional remodeling in healthy middle-aged and older individuals","volume":"45","author":"Rahman","year":"2025","journal-title":"Clin Physiol Funct Imaging"},{"key":"R35-20260415","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1007\/s11606-022-07523-3","article-title":"Factors associated with post-acute sequelae of SARS-CoV-2 (PASC) after diagnosis of symptomatic COVID-19 in the inpatient and outpatient setting in a diverse cohort","volume":"37","author":"Yoo","year":"2022","journal-title":"J Gen Intern Med"},{"key":"R36-20260415","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/echo.70120","article-title":"Myocardial dysfunction and risk of long COVID in patients recovered from mild and moderate COVID-19","volume":"42","author":"Zhou","year":"2025","journal-title":"Echocardiography"},{"key":"R37-20260415","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.echo.2024.09.006","article-title":"Cardiac function and functional capacity in patients with long COVID: A comparison to propensity-matched community controls","volume":"38","author":"Marwick","year":"2025","journal-title":"Journal of the American Society of Echocardiography"},{"key":"R38-20260415","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fcvm.2024.1357349","article-title":"Trajectories of functional and structural myocardial parameters in post-COVID-19 syndrome\u2014insights from mid-term follow-up by cardiovascular magnetic resonance","volume":"11","author":"Gr\u00f6schel","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"R39-20260415","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1186\/s12879-025-10774-0","article-title":"Cardiac symptoms in patients 3\u20136 months after contracting COVID-19\u2013data from the polish STOP-COVID registry","volume":"25","author":"Babicki","year":"2025","journal-title":"BMC Infect Dis"},{"key":"R40-20260415","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.amjcard.2022.06.023","article-title":"Risk of Cardiovascular Events After COVID-19","volume":"179","author":"Tereshchenko","year":"2022","journal-title":"Am J Cardiol"},{"issue":"(Suppl 1)","key":"R41-20260415","article-title":"Incidence of myocarditis among patients recovered from COVID-19 infection identified using cardiac magnetic resonance imaging","volume":"44","author":"Tugade","year":"2023","journal-title":"Eur Heart J"},{"key":"R42-20260415","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":"R43-20260415","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bcr-2021-241914","article-title":"Cardiorenal syndrome in COVID-19","volume":"14","author":"Ali","year":"2021","journal-title":"BMJ Case Rep"},{"key":"R44-20260415","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1002\/ejhf.2347","article-title":"Recovery of cardiac function following COVID-19 \u2013ECHOVID-19: A prospective longitudinal cohort study","volume":"23","author":"Lassen","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"R45-20260415","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1093\/eurheartj\/ehaa587","article-title":"Assessing left ventricular systolic function: From ejection fraction to strain analysis","volume":"42","author":"Halliday","year":"2021","journal-title":"Eur Heart J"},{"key":"R46-20260415","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1136\/heartjnl-2014-305538","article-title":"Prognostic implications of global LV dysfunction: A systematic review and meta-analysis of global longitudinal strain and ejection fraction","volume":"100","author":"Kalam","year":"2014","journal-title":"Heart"},{"key":"R47-20260415","first-page":"40","article-title":"Myocardial late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging (CMR)\u2014An important risk marker for cardiac disease","volume":"11","author":"Meier","year":"2024","journal-title":"J Cardiovasc Dev Dis"},{"key":"R48-20260415","doi-asserted-by":"crossref","first-page":"189","DOI":"10.3390\/jcm14010189","article-title":"Baseline and follow-up cardiac magnetic resonance imaging findings in children with acute myocarditis and factors associated with late gadolinium enhancement","volume":"14","author":"Yukcu","year":"2024","journal-title":"J Clin Med"},{"key":"R49-20260415","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12968-023-00925-0","article-title":"Revisiting how we perform late gadolinium enhancement CMR: Insights gleaned over 25 years of clinical practice","volume":"25","author":"Jenista","year":"2023","journal-title":"J Cardiovascular Magn Reson"},{"key":"R50-20260415","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1093\/cvr\/cvae090","article-title":"The complexity of cardiovascular long COVID: Where we are","volume":"120","author":"Gandhi","year":"2024","journal-title":"Cardiovasc Res"},{"key":"R51-20260415","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1186\/s12913-022-08384-6","article-title":"Possible long COVID healthcare pathways: A scoping review","volume":"22","author":"Wolf","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"R52-20260415","first-page":"726","article-title":"Beyond acute COVID-19: A review of long-term cardiovascular outcomes","volume":"39","author":"Parhizgar","year":"2023","journal-title":"Can J Cardiol"},{"key":"R53-20260415","first-page":"101482","article-title":"Cardiovascular disease and covid-19: A systematic review","volume":"54","author":"Krishna","year":"2024","journal-title":"Int J Cardiol Heart Vasc"},{"key":"R54-20260415","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12963-024-00338-w","article-title":"Cardiovascular risk and the COVID-19 pandemic: A population-based and case\u2012control studies","volume":"22","author":"Chlabicz","year":"2024","journal-title":"Popul Health Metr"},{"key":"R55-20260415","doi-asserted-by":"crossref","first-page":"100604","DOI":"10.1016\/j.lanepe.2023.100604","article-title":"Severe COVID-19 outcomes by cardiovascular risk profile in England in 2020: A population-based cohort study","volume":"27","author":"Warren-Gash","year":"2023","journal-title":"Lancet Reg Health Eur"},{"key":"R56-20260415","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1093\/cvr\/cvae049","article-title":"Persistent increase of cardiovascular and cerebrovascular events in COVID-19 patients: A 3-year population-based analysis","volume":"120","author":"Battistoni","year":"2024","journal-title":"Cardiovasc Res"},{"key":"R57-20260415","doi-asserted-by":"crossref","first-page":"1422393","DOI":"10.3389\/fmicb.2024.1422393","article-title":"Risk stratification and prediction of severity of COVID-19 infection in patients with preexisting cardiovascular disease","volume":"15","author":"Matejin","year":"2024","journal-title":"Front Microbiol"},{"key":"R58-20260415","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jcct.2020.06.003","article-title":"Recommendations for risk stratified use of cardiac computed tomography for congenital heart disease during the COVID-19 pandemic","volume":"14","author":"Farooqi","year":"2020","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"R59-20260415","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/jcmm.17122","article-title":"A close-up view of dynamic biomarkers in the setting of COVID-19: Striking focus on cardiovascular system","volume":"26","author":"Rezabakhsh","year":"2022","journal-title":"J Cell Mol Med"},{"key":"R60-20260415","doi-asserted-by":"crossref","first-page":"922","DOI":"10.3390\/cells11060922","article-title":"Biomarkers associated with cardiovascular disease in COVID-19","volume":"11","author":"Kaufmann","year":"2022","journal-title":"Cells"},{"key":"R61-20260415","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.clinbiochem.2022.06.002","article-title":"Serial cardiac biomarkers for risk stratification of patients with COVID-19","volume":"107","author":"Tawiah","year":"2022","journal-title":"Clin Biochem"},{"key":"R62-20260415","doi-asserted-by":"crossref","first-page":"3218","DOI":"10.3390\/ijms26073218","article-title":"Cardiovascular biomarkers: Tools for precision diagnosis and prognosis","volume":"26","author":"Netala","year":"2025","journal-title":"Int J Mol Sci"},{"key":"R63-20260415","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.3390\/diagnostics13152508","article-title":"Cardiac biomarkers and their role in identifying increased risk of cardiovascular complications in COVID-19 patients","volume":"13","author":"Yaluri","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"R64-20260415","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.amjmed.2023.05.002","article-title":"Multidisciplinary center care for long COVID syndrome\u2013A retrospective cohort study","volume":"138","author":"Bailey","year":"2025","journal-title":"Am J Med"},{"key":"R65-20260415","first-page":"e59478","article-title":"Multidisciplinary management strategies for long COVID: A narrative review","volume":"16","author":"Prusinski","year":"2024","journal-title":"Cureus"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_214_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:56:30Z","timestamp":1786647390000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_214_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":63,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_214_25","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-08-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}