A review of long COVID cardiovascular complications identifies natriuretic peptides, troponins, and emerging biomarkers like endothelin-1 and galectin-3 as key tools for detecting and monitoring heart damage in long COVID patients.
Multiple peptide biomarkersBNP/NT-proBNP, endothelin-1, and GDF-15 are among the peptide biomarkers that can detect hidden cardiovascular damage in long COVID patients
What the researchers found
The review categorizes long COVID cardiovascular biomarkers into established and emerging groups. Established markers include cardiac troponins (heart muscle damage), natriuretic peptides BNP/NT-proBNP (heart stress and failure), D-dimer (clotting), and inflammatory markers like C-reactive protein and interleukin-6.
Emerging biomarkers with clinical potential include growth differentiation factor-15 (GDF-15, a stress-responsive peptide), galectin-3 (fibrosis and inflammation), von Willebrand factor (endothelial damage), endothelin-1 (a vasoconstrictor peptide indicating vascular dysfunction), and circulating microRNAs. The review emphasizes that no single biomarker is sufficient — combinations and longitudinal monitoring will be needed for effective clinical use in long COVID cardiovascular management.
Why it matters
Millions of people worldwide have long COVID, and cardiovascular complications are among the most dangerous. Many patients have subtle heart damage that standard exams miss. Peptide biomarkers like BNP and endothelin-1 can detect this damage through a simple blood test, potentially allowing early intervention before heart failure or other serious complications develop. Better biomarker strategies could personalize follow-up care for the millions of long COVID patients.
How the study worked
This is a narrative review article that synthesizes the current literature on cardiovascular manifestations of long COVID and the biomarkers used for diagnosis, risk stratification, and therapy monitoring. The authors reviewed both established cardiac biomarkers with proven clinical utility and emerging candidates with preliminary evidence in the long COVID context.
What this study cannot tell us
As a narrative review, this paper does not perform meta-analysis or systematic evidence grading. Many of the emerging biomarkers lack large-scale validation studies specific to long COVID. There is no standardization in biomarker testing protocols across studies, making direct comparisons difficult. The review acknowledges the absence of validated longitudinal predictive models for cardiovascular outcomes in long COVID.
How to read the evidence
This is a narrative review synthesizing evidence from multiple studies. While it provides a comprehensive overview of available and emerging biomarkers, it does not include systematic methodology or meta-analysis of diagnostic accuracy across studies.
When this study was published
Published in 2026, this is a very current review capturing the latest understanding of long COVID cardiovascular biomarkers, including emerging candidates not yet widely studied.
The bigger picture
This review highlights how peptide biology is central to understanding and managing long COVID heart damage. Natriuretic peptides have been cornerstones of heart failure diagnosis for decades, and their relevance extends seamlessly to long COVID. The emergence of newer peptide markers like endothelin-1 and GDF-15 reflects a broader trend in medicine: using the body's own signaling peptides as diagnostic windows into disease processes. As long COVID research matures, these biomarkers may become standard components of post-infection cardiovascular screening.
Questions still open
- Could a multi-biomarker panel combining natriuretic peptides, troponins, and endothelin-1 reliably predict which long COVID patients will develop heart failure?
- How do peptide biomarker levels in long COVID compare to those seen in traditional heart failure or other post-viral cardiovascular conditions?
- Would serial monitoring of natriuretic peptides over months help guide treatment decisions for long COVID cardiovascular patients?
Common questions
What are natriuretic peptides and why are they important in long COVID?
Can a blood test really detect heart damage from long COVID?
Read the original research
Cardiovascular burden of long coronavirus disease: Clinical challenges and emerging biomarkers.
World journal of cardiology, 18(1), 112466
Citation
Aguiar, Carlos Eduardo Oliveira; Costa, Juan Marcos Caram; Oliveira, Marina Maria Gomes Leite; Lopes, Caio Ferraz; Lima, Pedro Henrique Melo; Dietrich, Victoria Cenci; Grenfell, Rafaella Fortini Queiroz; de Melo, Fabrício Freire. (2026). Cardiovascular burden of long coronavirus disease: Clinical challenges and emerging biomarkers.. World journal of cardiology, 18(1), 112466. https://doi.org/10.4330/wjc.v18.i1.112466