Risk of Heart Failure in the Post COVID-19 Era: Insights from a New Cardiac Model Study
A study called “Predicted risk of heart failure pandemic due to persistent SARS-CoV-2 infection using a three-dimensional cardiac model”, utilizing a novel human iPS cell-derived cardiac microtissue (CMT) model, provides crucial insights into the potential long-term cardiac effects of SARS-CoV-2 infection, raising concerns about a possible global heart failure pandemic in the post-COVID-19 era.
- Persistent SARS-CoV-2 Infection Model: The study developed a model of persistent SARS-CoV-2 infection using human iPS cell-derived CMTs. It was observed that even mild infections could sustain viral presence without significant dysfunction for a month, indicating persistent infection. However, under hypoxic conditions that mimic ischemic heart diseases, cardiac function deteriorated alongside intracellular SARS-CoV-2 reactivation in cardiomyocytes and disrupted vascular network formation.
- Impact of Hypoxic Stress: The model showed that patients with a history of mild SARS-CoV-2 infection, who might develop slight cardiac dysfunction, could be at risk of heart failure under additional stressors like hypoxia. Under hypoxic stress mimicking ischemic heart disease, persistently infected CMTs exhibited further deterioration of contractile function, indicating that hypoxic stress disrupted vascular network formation possibly due to the reactivation of SARS-CoV-2.
- Inflammatory Cytokines: Interestingly, the study found that the application of hypoxic stress to the persistent infection model did not lead to the upregulation of inflammatory cytokines typically associated with COVID-19, such as IL-6, TNF-α, IL-1β, and IFN-γ. This suggests that the reduced cardiac function observed under hypoxic stress is not dependent on the expression level of these cytokines.
- Clinical Implications and Future Research: This research indicates that cardiac tissues under persistent SARS-CoV-2 infections are at high risk of cardiac dysfunction with additional hypoxic stress. The findings imply that patients, superficially maintaining cardiac function, could be at a marginal risk of developing heart failure, especially under additional stress. Future research is needed to validate these aspects, particularly by incorporating immune factors into the persistent infection model.
In summary, this study underscores the potential for a significant increase in heart failure cases in the post-COVID-19 era, driven by the persistent effects of SARS-CoV-2 on cardiac function. The findings highlight the importance of monitoring and managing the long-term cardiovascular impacts of COVID-19.