**4. Future directions and conclusions**

Since many aspects of the PACS remain unclear, further studies will be needed to shed light on the following aspects. First, establish the prevalence SARS-CoV-2-induced CV injury and CV sequelae of PACS. Second, define univocal and universal diagnostic criteria for long-COVID-19, based not only on clinical symptoms but also on specific biomarkers.

*Perspective Chapter: Cardiovascular Post-Acute COVID-19 Syndrome – Definition, Clinical... DOI: http://dx.doi.org/10.5772/intechopen.109292*

Third, identify novel therapeutic solutions or novel use of old drugs to prevent and treat or COVID-19 long-term CV injury. Finally, he long-term prognostic impact of cardiovascular sequelae of SARS-CoV-2 infection in both healthy subjects as well as in patients with preexisting cardiac diseases (e.g. ischemic heart disease, heart failure) is evaluated in order to clarify whether SARS-Cov2 infection or its sequelae beyond the acute phase of COVID-19 may represent a novel risk factor for future cardiovascular disease. In fact, data from the national healthcare databases from the US Department of Veterans Affairs including a large cohort of 153,760 individuals with COVID-19 compared to two sets of control cohorts (5,637,647 contemporary controls and 5,859,411 historical controls) showed that, beyond the first 30 days after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disease [194, 195]. Moreover, these risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized, and admitted to intensive care), thereby providing novel evidence of post-COVID-19 cardiovascular prognostic impact. In particular, if these data will be confirmed, the presence of a SARS-Cov2 infection as well as a history of PACS should be considered in the future as a novel parameter in cardiovascular risk estimation beyond traditional cardiovascular risk factors.

#### **Conflict of interest**

The authors declare no conflict of interest.

Figures and tables, part of the manuscript, were drawn by the authors and therefore are to be considered an original contribution.

#### **Author details**

Claudio Stefano Centorbi1 \*, Enrica Garau1 , Leonardo Borsi<sup>2</sup> , Valerio Brambilla2 , Lorenzo Brambilla<sup>3</sup> and Davide Lazzeroni<sup>2</sup>

1 Brotzu Hospital, Paediatric Cardiology and Congenital Heart Disease Unit, Cagliari, Italy

2 Fondazione Don Carlo Gnocchi, Parma, Italy

3 IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy

\*Address all correspondence to: doc.centorbi@gmail.com

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
