Distinct Cytokine Patterns Identify Acute and Convalescent Myocardial Involvement After Coronavirus Disease 2019: A Multicohort Biomarker Study.

We sought to identify the immunobiologic underpinnings of cardiac involvement as a postacute sequela of coronavirus disease 2019 (COVID-19) by comparing acute and convalescent populations. For the latter, an integrated analysis of cytokine levels, cardiac magnetic resonance imaging, and cardiopulmonary exercise capacity was performed. Unlike acute cardiac injury, which was associated with heightened tumor necrosis factor alpha (TNF-α) but not interleukin 18 (IL-18), convalescent myocardial inflammation/edema correlated with IL-18 but not TNF-α. Thus, inflammation is not a monolith in relation to cardiac involvement in the setting of COVID-19. Instead, convalescent cardiac involvement may emerge from mechanisms distinct from acute injury, and appropriately targeted therapies may prevent postacute sequalae of COVID-19.
Competing Interests: Potential conflicts of interest. D. A. Z. has received educational honoraria from Medtronic. G. A. M. has received grant support from ViiV, Vanda, and Genentech, and served as a scientific advisor for Gilead, Merck, ViiV/GSK, and Janssen. D. D. A. reports support from Cellular Technologies Ltd. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)