Background: The long-term cardiovascular sequelae of SARS-CoV-2 infection have emerged as a significant global health concern. Dilated cardiomyopathy (DCM) is a serious potential complication of the post-acute phase of COVID-19, often resulting from persistent myocardial inflammation or autoimmune dysregulation. Objective: This article reviews current evidence regarding the pathophysiology, diagnosis, and management of post-COVID-19 DCM and highlights the clinical challenges in distinguishing it from idiopathic forms. Methods: A comprehensive review of literature published between 2020 and 2024 was conducted using PubMed, Scopus, and Google Scholar databases. Studies focusing on cardiac magnetic resonance (CMR) findings, biopsy-proven myocarditis, and heart failure outcomes in post-COVID patients were analyzed. Results: Evidence suggests that post-COVID-19 DCM develops through direct viral toxicity, cytokine-mediated injury, and endothelial dysfunction. CMR studies reveal late gadolinium enhancement (LGE) in a subset of recovered patients, indicating myocardial fibrosis. Conclusion: Post-COVID-19 DCM requires a high index of suspicion. Early initiation of guideline-directed medical therapy (GDMT) is crucial. Long-term longitudinal studies are needed to determine the reversibility of this condition.

COVID-19, dilated cardiomyopathy, heart failure, myocarditis, cardiac MRI, SARS-CoV-2.

Basso, C., Leone, O., Rizzo, S., et al. (2021). Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study. European Heart Journal, 41(39), 3827-3835. https://doi.org/10.1093/eurheartj/ehaa664

Puntmann, V. O., Carerj, M. L., Wieters, I., et al. (2020). Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiology, 5(11), 1265–1273. https://doi.org/10.1001/jamacardio.2020.3557

Tschöpe, C., Ammirati, E., Bozkurt, B., et al. (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nature Reviews Cardiology, 18, 169–193.

Sandoval, Y., Januzzi, J. L., & Jaffe, A. S. (2020). Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. Journal of the American College of Cardiology, 76(10), 1244-1258.

Caforio, A. L. P., Pankuweit, S., Arbustini, E., et al. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart Journal, 34(33), 2636–2648. (Used for comparison standards).

Xie, Y., Xu, E., Bowe, B., & Al-Aly, Z. (2022). Long-term cardiovascular outcomes of COVID-19. Nature Medicine, 28, 583–590.