Cardiovascular burden of long coronavirus disease: Clinical challenges and emerging biomarkers

Table 1 Cardiovascular biomarkers of clinical importance in long coronavirus disease

Ref.	Biomarker	Category	Alteration in long coronavirus disease	Potential clinical utility
[29,106,107]	Troponins	Myocardial injury	Persistent elevated levels for up to 6 months in 15%-30% of patients, even without clinical heart failure symptoms	Indication of subclinical myocardial injury; associated with MACE and poorer prognosis
[112,118,119]	NT-proBNP/BNP	Hemodynamic stress	Elevated in approximately 11% of LC cases; levels around 1000 pg/mL predictive of mortality	Predictor of MACE and mortality
[112,124,125]	D-dimer	Coagulation activation	Elevated in approximately 20% of LC cases	Indicates thromboembolic risk and ongoing vascular inflammation
[132-134]	IL-6	Systemic inflammation	Elevated in approximately 48% of recovered patients; association with cardiovascular autonomic dysfunction	Marker of sustained inflammation
[136]	CRP	Chronic inflammation	Frequently elevated in symptomatic patients; paradoxically, low levels (≤ 3 mg/L) associated with CMR abnormalities	Assessment of cardiovascular risk and chronic inflammation
[139]	Ferritin	Inflammation; iron storage	Elevated up to 12 months in LC patients	Assessment of cardiovascular risk and persistent inflammation
[145,146]	vWF (Ag)/ADAMTS13	Endothelial dysfunction; thrombosis	Ratio ≥ 1.5 in approximately 33% of patients; correlated with desaturation and exercise intolerance	Indicates prothrombotic state and endothelial injury
[134,147]	ET-1	Vascular dysfunction	Elevated up to 3 months post-infection; persists in symptomatic individuals	Suggests microvascular dysfunction

NT-proBNP: N-terminal pro-B-type natriuretic peptide; BNP: B-type natriuretic peptide; vWF: Von Willebrand factor; LC: Long coronavirus disease; CMR: Cardiovascular magnetic resonance imaging; MACE: Major adverse cardiovascular events; ADAMTS13: A disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13.