Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection.

BACKGROUND: Long COVID is associated with multiple symptoms and impairment in multiple organs. Cross-sectional studies have reported cardiac impairment to varying degrees by varying methodologies. Using cardiac MR (CMR), we investigated a 12-month trajectory of abnormalities in Long COVID. OBJECTIVES: To investigate cardiac abnormalities 1-year post-SARS-CoV-2 infection. METHODS: 534 individuals with Long COVID underwent CMR (T1/T2 mapping, cardiac mass, volumes, function and strain) and multiorgan MRI at 6 months (IQR 4.3-7.3) since first post-COVID-19 symptoms. 330 were rescanned at 12.6 (IQR 11.4-14.2) months if abnormal baseline findings were reported. Symptoms, questionnaires and blood samples were collected at both time points. CMR abnormalities were defined as ≥1 of low left or right ventricular ejection fraction (LVEF), high left or right ventricular end diastolic volume, low 3D left ventricular global longitudinal strain (GLS), or elevated native T1 in ≥3 cardiac segments. Significant change over time was reported by comparison with 92 healthy controls. RESULTS: Technical success of multiorgan and CMR assessment in non-acute settings was 99.1% and 99.6% at baseline, and 98.3% and 98.8% at follow-up. Of individuals with Long COVID, 102/534 (19%) had CMR abnormalities at baseline; 71/102 had complete paired data at 12 months. Of those, 58% presented with ongoing CMR abnormalities at 12 months. High sensitivity cardiac troponin I and B-type natriuretic peptide were not predictive of CMR findings, symptoms or clinical outcomes. At baseline, low LVEF was associated with persistent CMR abnormality, abnormal GLS associated with low quality of life and abnormal T1 in at least three segments was associated with better clinical outcomes at 12 months. CONCLUSION: CMR abnormalities (left entricular or right ventricular dysfunction/dilatation and/or abnormal T1mapping), occurred in one in five individuals with Long COVID at 6 months, persisting in over half of those at 12 months. Cardiac-related blood biomarkers could not identify CMR abnormalities in Long COVID. TRIAL REGISTRATION NUMBER: NCT04369807.

Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study.

OBJECTIVES: To determine the prevalence of organ impairment in long COVID patients at 6 and 12 months after initial symptoms and to explore links to clinical presentation. DESIGN: Prospective cohort study. PARTICIPANTS: Individuals. METHODS: In individuals recovered from acute COVID-19, we assessed symptoms, health status, and multi-organ tissue characterisation and function. SETTING: Two non-acute healthcare settings (Oxford and London). Physiological and biochemical investigations were performed at baseline on all individuals, and those with organ impairment were reassessed. MAIN OUTCOME MEASURES: Primary outcome was prevalence of single- and multi-organ impairment at 6 and 12 months post COVID-19. RESULTS: A total of 536 individuals (mean age 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post COVID-19); 331 (62%) with organ impairment or incidental findings had follow-up, with reduced symptom burden from baseline (median number of symptoms 10 and 3, at 6 and 12 months, respectively). Extreme breathlessness (38% and 30%), cognitive dysfunction (48% and 38%) and poor health-related quality of life (EQ-5D-5L < 0.7; 57% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single-organ impairment. Single- and multi-organ impairment were present in 69% and 23% at baseline, persisting in 59% and 27% at follow-up, respectively. CONCLUSIONS: Organ impairment persisted in 59% of 331 individuals followed up at 1 year post COVID-19, with implications for symptoms, quality of life and longer-term health, signalling the need for prevention and integrated care of long COVID.Trial Registration: ClinicalTrials.gov Identifier: NCT04369807.

WHAT BOARDS HAVE LEARNED FROM THE PANDEMIC

Eighteen months have passed since COVID-19 slammed into the world. It's been quite a journey from those first days of panic to, well, whatever this is today. People can't really say the pandemic has faded from view -- because while it has faded in North America, Europe, and several other countries, it hasn't receded in much of the developing world. They can say, however, that the challenge of COVID-19 has changed. It has evolved from an acute condition, threatening the survival of the organization, to a chronic one that must be managed. COVID-19 exerted enormous influence over the duties and details of corporate governance, and it's likely to keep doing that for a long while yet.

COVID-19: THE ULTIMATE GOVERNANCE CHALLENGE

In many ways, the coronavirus (COVID-19) pandemic is the corporate governance crisis we've been preparing for all our lives. It is a public health crisis that has caused an economic crisis, which for many organizations has also caused operational or liquidity crises. Its consequences dwarf the financial crisis of 2008 and the September 11 attacks combined. It is global in scope and unending in duration. And yet, corporate boards, management, and internal audit teams have to confront this menace somehow. As companies are scrambling to understand what their new risks are, and how to amend business processes to keep those risks at acceptable levels, internal audit has an important role to play. It is internal audit's job, after all, to perform critical assessments of emerging risks, use data analytics to build monitoring tools, and counsel management on possible changes to business processes. Internal audit can especially look at technology risks, including ones that might arise from adopting new work-from-home processes in haste.

WHAT COVID-19 TEACHES US ABOUT ESG'S IMPORTANCE

They say that even a kick in the rear is a step forward, and COVID-19 has delivered one mighty kick to corporate posteriors around the world. Now one question is whether boards will lurch forward--on, of all things, environmental, social, and governance (ESG) issues. The ties between COVID-19 and ESG performance are more direct than one might assume. The virus has forced organizations to consider a host of specific questions, but the deeper, existential questions boards face are two: How can they preserve sustainable operations amid unpredictable circumstances? And, how can they hold all their stakeholders together and continue to create value? Here, Kelly cites that understanding the connection between Covid-19 and ESG issues may be key to corporate resilience.