Improvement of clinical symptoms and cardiac abnormalities detected by cardiac magnetic resonance imaging in patients with long COVID syndrome after guideline-oriented therapy

Abstract Patients with cardiovascular long COVID syndrome and cardiac magnetic resonance (CMR) scans were included prospectively into the Vienna PostCoV Registry between March 2021 and March 2023 (EC: 1008/2021, clinicaltrials.gov NCT05398952; n=240). Clinical symptoms, age and sex, time between COVID-positivity and vaccination and CMR, as well as CMR findings were recorded. After medical treatment, clinical assessment and CMR was repeated in 67 patients with pathological CMR findings showing myopericarditis, pericardial effusion or cardiac functional abnormalities. Blood pressure and condition-adapted heart failure treatment led to a significant increase in left ventricular ejection fraction. Low-moderate doses of NSAIDs for 3 months significantly reduced pericardial effusion. Clinical symptoms improved markedly with a decrease in CMR abnormalities. In conclusion, medical treatment of cardiac/cardiovascular long COVID syndrome related to CMR abnormalities led to significant improvement in ejection fraction and decreased pericardial effusion, and were associated with improvements in the cardiovascular long COVID complaints.