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Schellenberg J, Matits L, Bizjak DA, Kersten J, Kirsten J, Vollrath S, Steinacker JM. Assessment of myocardial function and cardiac performance using left ventricular global longitudinal strain in athletes after COVID-19: a follow-up study. Front Cardiovasc Med 2023; 10:1240278. [PMID: 37876776 PMCID: PMC10591089 DOI: 10.3389/fcvm.2023.1240278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background It has not yet been conclusively determined whether reduced left ventricular global longitudinal strain (LV GLS) after COVID-19 contributes to a reduction in exercise capacity. Our own studies showed a possible mild myocardial involvement in the form of reduced LV GLS in athletes after COVID-19 compared with healthy athletes. The aims of this prospective follow-up study were to investigate the development of LV GLS over a 3-month period in athletes after COVID-19 and the possible relationship between LV GLS and physical performance. Methods LV GLS was determined in four-, two-, and three-chamber views and assessed offline by a blinded investigator in 96 recreational athletes (mean age 33.15 ± 12.40 years, 53 male, peak VO2 38.82 ± 11.14 ml/min/kg) at a median of two (t0) and five months (t1) after COVID-19. Cardiopulmonary exercise testing (CPET) was performed on a bicycle ergometer on both examination dates. Results LV GLS improved significantly between t0 and t1 (t0 -18.82 ± 2.02 vs. t1 -19.46 ± 2.05, p < 0.001). Echocardiographic and spiroergometric parameters were within the normal clinical reference range. Maximum power increased significantly from t0 to t1 (t0 283.17 ± 83.20 vs. t1 286.24 ± 85.22 Watt, p = 0.009) and there was a trend toward increased peak oxygen uptake (t0 36.82 ± 11.14 vs. t1 38.68 ± 10.26 ml/min/kg, p = 0.069). We found no correlation between LV GLS and performance parameters, except for the respiratory exchange ratio (RER) [ρ -0.316, (-0.501; -0.102), p < 0.050]. Conclusions Significant improvement in LV GLS approximately five months after COVID-19 may be due to mild myocardial involvement during or shortly after COVID-19, which seems to recover. There was no correlation between LV GLS and performance parameters, except for an inverse correlation of LV GLS and RER, suggesting insufficient exercise intolerance at lower GLS values. Further studies on the development of GLS in athletes or in the general population with moderate and severe disease courses would be informative as well as the comparison of pre-COVID-19 with post-COVID-19 echocardiography to evaluate the effects of COVID-19 on cardiac function.
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Affiliation(s)
- J. Schellenberg
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - L. Matits
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - D. A. Bizjak
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - J. Kersten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - J. Kirsten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - S. Vollrath
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
| | - J. M. Steinacker
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany
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Schellenberg J, Ahathaller M, Matits L, Kirsten J, Kersten J, Steinacker JM. Left Ventricular Global Longitudinal Strain as a Parameter of Mild Myocardial Dysfunction in Athletes after COVID-19. J Cardiovasc Dev Dis 2023; 10:jcdd10050189. [PMID: 37233156 DOI: 10.3390/jcdd10050189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Whether symptoms during COVID-19 contribute to impaired left ventricular (LV) function remains unclear. We determine LV global longitudinal strain (GLS) between athletes with a positive COVID-19 test (PCAt) and healthy control athletes (CON) and relate it to symptoms during COVID-19. GLS is determined in four-, two-, and three-chamber views and assessed offline by a blinded investigator in 88 PCAt (35% women) (training at least three times per week/>20 MET) and 52 CONs from the national or state squad (38% women) at a median of two months after COVID-19. The results show that the GLS is significantly lower (GLS -18.53 ± 1.94% vs. -19.94 ± 1.42%, p < 0.001) and diastolic function significantly reduces (E/A 1.54 ± 0.52 vs. 1.66 ± 0.43, p = 0.020; E/E'l 5.74 ± 1.74 vs. 5.22 ± 1.36, p = 0.024) in PCAt. There is no association between GLS and symptoms like resting or exertional dyspnea, palpitations, chest pain or increased resting heart rate. However, there is a trend toward a lower GLS in PCAt with subjectively perceived performance limitation (p =0.054). A significantly lower GLS and diastolic function in PCAt compared with healthy peers may indicate mild myocardial dysfunction after COVID-19. However, the changes are within the normal range, so that clinical relevance is questionable. Further studies on the effect of lower GLS on performance parameters are necessary.
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Affiliation(s)
- Jana Schellenberg
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
| | - Magdalena Ahathaller
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
| | - Lynn Matits
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, 89075 Ulm, Germany
| | - Johannes Kirsten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
| | - Johannes Kersten
- Division of Sports and Rehabilitation Medicine, University Ulm Hospital, 89075 Ulm, Germany
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Sirico D, Di Chiara C, Costenaro P, Bonfante F, Cozzani S, Plebani M, Reffo E, Castaldi B, Donà D, Da Dalt L, Giaquinto C, Di Salvo G. Left ventricular longitudinal strain alterations in asymptomatic or mildly symptomatic paediatric patients with SARS-CoV-2 infection. Eur Heart J Cardiovasc Imaging 2022; 23:1083-1089. [PMID: 34219155 DOI: 10.1093/ehjci/jeab127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023] Open
Abstract
AIMS Compared with adult patients, clinical manifestations of children's coronavirus disease-2019 (COVID-19) are generally perceived as less severe. The objective of this study was to evaluate cardiac involvement in previously healthy children with asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. METHODS AND RESULTS We analysed a cohort of 53 paediatric patients (29 males, 55%), mean age 7.5 ± 4.7 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or only mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study at least 3 months after diagnosis. Thirty-two age, sex, and body surface area comparable healthy subjects were used as control group. Left ventricular ejection fraction was within normal limits but significantly lower in the cases group compared to controls (62.4 ± 4.1% vs. 65.2 ± 5.5%; P = 0.012). Tricuspid annular plane systolic excursion (20.1 ± 3 mm vs. 19.8 ± 3.4 mm; P = 0.822) and left ventricular (LV) global longitudinal strain (-21.9 ± 2.4% vs. -22.6 ± 2.5%; P = 0.208) were comparable between the two groups. Regional LV strain analysis showed a significant reduction of the LV mid-wall segments strain among cases compared to controls. Furthermore, in the cases group, there were 14 subjects (26%) with a regional peak systolic strain below -16% (-2.5 Z score in our healthy cohort) in at least two segments. These subjects did not show any difference regarding symptoms or serological findings. CONCLUSION SARS-CoV-2 infection may affect left ventricular deformation in 26% of children despite an asymptomatic or only mildly symptomatic acute illness. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes.
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Affiliation(s)
- Domenico Sirico
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Costanza Di Chiara
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Paola Costenaro
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università 10, 35020 Legnaro, Italy
| | - Sandra Cozzani
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Elena Reffo
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Biagio Castaldi
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Daniele Donà
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Liviana Da Dalt
- Department for Women's and Children's Health, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Carlo Giaquinto
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Giovanni Di Salvo
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
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Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children. J Clin Med 2021; 10:jcm10153360. [PMID: 34362141 PMCID: PMC8348478 DOI: 10.3390/jcm10153360] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) is a known severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the early cardiac abnormalities in patients with MIS-C, evaluated by speckle tracking echocardiography (STE) and cardiac MRI (CMR). Clinical, laboratory and microbiological data were measured for all patients. All children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS). Seventeen (75%) of the children were evaluated with CMR. Twenty-three patients (13M, 10F) were recruited, mean age was 8.1 ± 4 years. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission. In-hospital survival was 100%. TnI was elevated in 15 (65.2%) and BNP in 20 (86.9%) patients. The median time to STE evaluation was 8 days and to CMR was 18 days after fever onset. Mean LVEF was 59 ± 10%. Coronary dilation was observed in six (26.1%) patients. STE showed a reduced mean LVGLS (-17 ± 4.3%). LGE with a non-ischemic pattern was evident in six out of seventeen patients (35.2%). The elevation of myocardial necrosis markers, the reduction of LVGLS and the presence of LGE on CMR in about a quarter of MIS-C patients supports the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis.
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