Vascular fibrosis and extracellular matrix remodelling in post-COVID 19 conditions

•COVID-19 research could be applicable to and inform on other post-viral syndromes and respiratory illnesses.•Histopathological evidence of increased collagen deposition, abnormal CMR findings and upregulated extracellular matrix remodelling related pathways suggests that systemic, and vascular inflammation, may contribute to symptom burden in post-COVID-19 syndromes.•Identification of candidate target pathways remains a challenge in myocarditis patients due to the complexity of presentation and lack of prospective tissue collection.•Trials are needed to provide clinical and scientific evidence to inform treatment decisions in post-COVID-19 syndromes. Causal associations between viral infections and acute myocardial injury are not fully understood, with mechanisms potentially involving direct cardiovascular involvement or systemic inflammation. This review explores plausible mechanisms of vascular fibrosis in patients with post-COVID-19 syndrome, focusing on extracellular matrix remodelling. Despite global attention, significant mechanistic or translational breakthroughs in the management of post-viral syndromes remain limited. No effective pharmacological or non-pharmacological interventions are currently available for patients experiencing persistent symptoms following COVID-19 infection. The substantial expansion of scientific knowledge resulting from collaborative efforts by medical experts, scientists, and government organisations in undertaking COVID-19 research could inform treatment strategies for other post-viral syndromes and respiratory illnesses. There is a critical need for clinical trials to evaluate potential therapeutic candidates, providing evidence to guide treatment decisions for post-COVID-19 syndromes. Central illustration [Display omitted]