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ABSTRACT
Background:
Cardiovascular disease (CVD) can occur in COVID-19 and has impact on clinical course. Data on CVD prevalence in hospitalized COVID-19 patients and sequelae in survivors is limited. Aim of this prospective study carried out on consecutive unselected COVID-19 population, was to assess: 1) CVD occurrence among hospitalized COVID-19 patients, 2) persistence or new onset of CVD at one-month and one-year follow-up.

Methods:
Over 30 days n = 152 COVID-19 patients underwent cardiovascular evaluation. Standard electrocardiogram (ECG), Troponin and echocardiography were integrated by further tests when indicated. Medical history, arterial blood gas, blood tests, chest computed tomography and treatment were recorded. CVD was defined as the occurrence of a new condition during the hospitalization for COVID-19. Survivors attended a one-month follow-up visit and a one-year telephone follow-up.

Results:
Forty-two patients (28%) experienced a wide spectrum of CVD with acute myocarditis being the most frequent. Death occurred in 32 patients (21%) and more frequently in patients who developed CVD (p = 0.032). After adjustment for confounders, CVD was independently associated with death occurrence. At one-month follow-up visit, 7 patients (9%) presented persistent or delayed CVD. At one-year telephone follow-up, 57 patients (48%) reported persistent symptoms.

Conclusion:
Cardiovascular evaluation in COVID-19 patients is crucial since the occurrence of CVD in hospitalized COVID-19 patients is common (28%), requires specific treatment and increases the risk of in-hospital mortality.

۱٫ Introduction
The outbreak of COronaVIrus Disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is mainly characterized by a pulmonary involvement. However, cardiovascular complications can occur. During the first wave of the pandemic early observations reported an increased level of Troponin in a proportion of patients (10–۱۲%) (۱,۲) associated with increased mortality (3). An increasing number of sporadic cases reporting cardiovascular involvement has been described afterwards, including Tako-Tsubo syndrome (4), ST-segment elevation (5) and other cases generally reported as myocarditis or myopericarditis (6,7).

Considering this growing evidence, studies based on echocardiographic evaluation were carried out which reported a high prevalence of cardiac involvement (8,9). However, these evaluations were limited to echocardiography without further cardiac examinations in case of positive findings.

The wide spectrum of cardiovascular complication can be related to the release of cytokines mediated by SARS-CoV-2, possibly causing myocardial inflammation in addition to vascular inflammation and plaque instability. Direct myocardial damage by the virus should also be considered despite the fact that undisputable localization of SARS-CoV-2 within cardiomyocytes has been not proven among the limited number of autopsies in COVID-19 (10–۱۴). The presence of cardiovascular risk factors or cardiac disease, both pre-existing and new, is related to poor prognosis (15–۱۸). Despite the detection of the new CVD appears of paramount importance for in-hospital management and clinical course, data from a systematic evaluation has been not reported yet.