Journal of the American Heart AssociationOct 14, 2025

Higher Risk of Long-Term Decrease in Heart Pumping Strength After COVID-19

Updated Jun 28, 2026

Abstract

Essence

COVID-19 was linked to a higher long-term risk of left ventricular ejection fraction decline, especially after hospitalization.

Evidence

This retrospective cohort analyzed 2853 COVID-positive and 3963 COVID-negative patients with normal baseline LVEF and follow-up echocardiograms using adjusted Cox models.

Caveat

The study was observational and limited to patients who had follow-up echocardiography, so it cannot prove causality, and vaccination was not significantly associated with LVEF decline.

Simplified

BACKGROUND: COVID-19 has been linked to cardiovascular complications, but its long-term impact on left ventricular (LV) function is unclear. We investigated whether SARS-CoV-2 infection is associated with increased risk of LV ejection fraction (LVEF) decline and whether vaccination mitigates this risk.

METHODS: In this retrospective study, we included patients with COVID-19, normal baseline LVEF (≥50%), and at least one follow-up echocardiogram from 2016 to 2024. Outcomes were LVEF dropping <50%, 40%, and 30%. Multivariable Cox models adjusted for demographics, comorbidities, vaccination status, and baseline LVEF. Associations with acute-phase blood biomarkers were examined.

RESULTS: Among 2853 patients who were COVID+ and 3963 patients who were COVID- (baseline LVEF ≥50%), patients with COVID-19 had lower mean follow-up LVEF (60.65% versus 61.53%,<0.005) and higher rates of LVEF decline <50%, 40%, and 30%. Both hospitalized (adjusted hazard ratio [aHR], 1.57 [1.30-1.91]) and non-hospitalized (aHR, 1.48 [1.18-1.85]) patients with COVID-19 had greater risk of LVEF <50% versus controls; only hospitalized patients had significantly increased risk of LVEF<40% (aHR, 1.81 [1.35-2.43]) and <30% (aHR, 2.79 [1.72-4.54]). Vaccination was not significantly associated with LVEF decline. Baseline LVEF, older age, male sex, history of heart failure, myocardial infarction, and chronic kidney disease were associated with greater risk. Elevated troponin, B-type natriuretic peptide, D-dimer, and thrombocytopenia predicted greater risk in hospitalized patients with COVID-19. P

CONCLUSIONS: SARS-CoV-2 infection is associated with long-term LVEF declines, especially in hospitalized patients. Vigilant cardiac surveillance may be needed in survivors of COVID-19 to mitigate progressive dysfunction.