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Shimoni O, Korenfeld R, Goland S, Meledin V, Haberman D, George J, Shimoni S. Subclinical Myocardial Dysfunction in Patients Recovered from COVID-19 Disease: Correlation with Exercise Capacity. BIOLOGY 2021; 10:biology10111201. [PMID: 34827194 PMCID: PMC8615112 DOI: 10.3390/biology10111201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Aims: Myocardial abnormalities are common during COVID-19 infection and recovery. We examined left (LV) and right (RV) ventricular longitudinal strain in patients who had recovered from COVID-19 and assessed the correlation with exercise capacity. Methods and results: One hundred and eighty-four consecutive patients with history of COVID-19 disease who had been referred to rest or stress echocardiography because of symptoms, mainly dyspnea and chest pain, were included in the study. These patients were compared to 106 patients with similar age, symptoms, and risk factor profile with no history of COVID-19 disease. Clinical and echocardiographic parameters, including strain imaging, were assessed. The patient’s age was 48 ± 12 years. Twenty-two patients had undergone severe disease. There were no differences in the LV ejection fraction and diastolic function between the groups. However, LV and RV global and free wall strain were significantly lower (in absolute numbers) in patients who had recovered form COVID-19 infection (−20.41 ± 2.32 vs −19.39 ± 3.36, p = 0.001, −23.69 ± 3.44 vs −22.09 ± 4.20, p = 0.001 and −27.24 ± 4.7 vs −25.43 ± 4.93, p = 0.021, respectively). Global Longitudinal Strain (GLS) < −20% was present in only 37% of post COVID-19 patients. Sixty-four patients performed exercise echocardiography. Patients with GLS < −20% had higher exercise capacity with higher peak metabolic equivalent and exercise time compared to patients with GLS ≥ −20% (12.6 ± 2 vs 10 ± 2.5 METss and 8:00 ± 2:08 vs 6:24 ± 2:03 min, p < 0.001 and p = 0.003, respectively). Conclusion: In patients, who had recovered from COVID-19 infection, both LV and RV strain are significantly lower compared to control patients. The exercise capacity of these patients correlates with LV strain values. Rest and stress echocardiography in patients with symptoms after COVID-19 infection may identify patients that need further follow up to avoid long term complications of the disease. These preliminary results warrant further research, to test the natural history of these findings and the need and timing of treatment.
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Affiliation(s)
- Or Shimoni
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Roman Korenfeld
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Sorel Goland
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
- Assuta Calaniot Medical Center, Ashdod 7706401, Israel
| | - Valery Meledin
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Dan Haberman
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Jacob George
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Sara Shimoni
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
- Assuta Calaniot Medical Center, Ashdod 7706401, Israel
- Correspondence:
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