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D'Ávila LBO, Milani M, Le Bihan DCS, de Lima ACGB, Milani JGPO, Cipriano GFB, da Silva VZM, Cipriano G. Longitudinal strain and myocardial work in symptomatic patients having recovered from COVID-19 and possible associations with the severity of the disease. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-023-03042-2. [PMID: 38277026 DOI: 10.1007/s10554-023-03042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024]
Abstract
COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann-Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56 years (IQR: 43-63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104-212) versus 121 (74-163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91-95) versus 94 (93-96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r2 = 0.167; p = 0.009; GWE: r2 = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.
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Affiliation(s)
- Luciana Bartolomei Orru D'Ávila
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil.
- Medcor, CLSW 105 Bloco A salas 37 a 39 Sudoeste, Brasilia, DF, CEP: 70670431, Brazil.
| | - Mauricio Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Rehabilitation Sciences Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - David C S Le Bihan
- University of São Paulo | USP Heart Institute São Paulo (InCor), São Paulo, SP, Brazil
| | | | - Juliana Goulart Prata Oliveira Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
| | - Graziella França Bernardelli Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Sciences Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Gerson Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
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Nour A, Fouad M, Salam ZA. Evaluation of cardiovascular autonomic dysfunction in symptomatic post-COVID-19 patients using the heart rate variability (HRV) and detection of subtle LV dysfunction using 2D global longitudinal strain (GLS). Int J Cardiovasc Imaging 2023; 39:2107-2118. [PMID: 37658987 PMCID: PMC10673727 DOI: 10.1007/s10554-023-02915-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 06/30/2023] [Indexed: 09/05/2023]
Abstract
AIM The COVID-19 disease primarily affects the respiratory system; however, cardiac involvement has been documented in the acute phase. We aimed to evaluate the cardiac autonomic function and subtle left ventricular dysfunction in those subjects recovered from mild to moderate acute COVID-19 patients but still symptomatic. METHODS AND RESULTS The study group was composed of 50 subjects with confirmed mild to moderate COVID-19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 h Holter monitoring for HRV analysis. The mean age of the study population was 42 ± 18 years; symptoms were reported as follows 27 (54%) had dyspnoea, 17 (34%) had palpitation, and 7 (14%) had dizziness. Time domain parameters Standard Deviation of NN intervals (SDNN), Standard Deviation of the Average NN intervals for each 5 min segment of a 24 h HRV recording (SDANN), and Root Mean Square of Successive RR interval Differences (rMSSD) were diminished with mean SDNN value being markedly impaired in 12 (24%) patients, while frequency domain parameters as assessed by the ratio of the Low-Frequency band power to the High-Frequency band power (LF/HF) with the mean of 1.837 with 8% of the patients being impaired. SDNN was significantly reduced in patients with impaired global longitudinal strain (p 0.000). The global longitudinal strain was diminished in 10 patients (20%); also, 80% of the patients with impaired GLS had decreased SDNN. CONCLUSION Our study targeted patients experiencing prolonged symptoms after COVID-19 illness. We detected a high incidence of GLS impairment using Speckle Tracking Echocardiography (STE) and a significant prevalence of diminished HRV. HRV (especially SDNN) and GLS were found to be significantly correlated.
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Affiliation(s)
- Amira Nour
- Cardiology department, Ain Shams University, Cairo, Egypt.
| | - Mirna Fouad
- Cardiology department, Ain Shams University, Cairo, Egypt
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3
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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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Mansour H, Abdelhady AO, Reheim WAA, William V. Can Global Longitudinal Strain Assess Asymptomatic Subtle Left Ventricular Dysfunction in Recovered COVID-19 Patients? J Cardiovasc Echogr 2023; 33:183-188. [PMID: 38486690 PMCID: PMC10936707 DOI: 10.4103/jcecho.jcecho_6_23] [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: 01/13/2023] [Revised: 10/16/2023] [Accepted: 12/10/2023] [Indexed: 03/17/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) might be associated with cardiac injury as a part of multisystem affection in response to cytokine storms. However, left ventricular (LV) function appears preserved in most of the cases, whereas subtle LV dysfunction might happen in others. Hence, we tried to detect subtle LV dysfunction in patients with COVID-19 using global longitudinal strain (GLS). Patients and Methods We performed a single-center observational study on 90 stable patients who were recently recovered from mild to moderate COVID-19 infections. A transthoracic echocardiographic examination was done for all patients, and GLS assessment was used as an indicator of LV function. Results The population age ranged from 27 to 66 years, and the majority of patients were males (54, 73.3%). Besides, 46.7% of the included patients were smokers, 33.3% had hypertension, and 23.3% were diabetics. All the patients had normal LV internal dimensions and ejection fractions. However, 33.3% of them had subclinical LV dysfunction as expressed by reduced GLS. There was no statistically significant correlation between GLS and age, gender, or other risk factors, whereas troponin and C-reactive protein significantly correlated with GLS. Conclusions Recovered patients from recent mild to moderate COVID-19 infections might show subtle LV dysfunction as manifested by reduced GLS.
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Affiliation(s)
- Hazem Mansour
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Aly Osama Abdelhady
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Viola William
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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5
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Kelly JD, Curteis T, Rawal A, Murton M, Clark LJ, Jafry Z, Shah-Gupta R, Berry M, Espinueva A, Chen L, Abdelghany M, Sweeney DA, Quint JK. SARS-CoV-2 post-acute sequelae in previously hospitalised patients: systematic literature review and meta-analysis. Eur Respir Rev 2023; 32:220254. [PMID: 37437914 PMCID: PMC10336551 DOI: 10.1183/16000617.0254-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Many individuals hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience post-acute sequelae of SARS-CoV-2 infection (PASC), sometimes referred to as "long COVID". Our objective was to conduct a systematic literature review and meta-analysis to identify PASC-associated symptoms in previously hospitalised patients and determine the frequency and temporal nature of PASC. METHODS Searches of MEDLINE, Embase, Cochrane Library (2019-2021), World Health Organization International Clinical Trials Registry Platform and reference lists were performed from November to December 2021. Articles were assessed by two reviewers against eligibility criteria and a risk of bias tool. Symptom data were synthesised by random effects meta-analyses. RESULTS Of 6942 records, 52 studies with at least 100 patients were analysed; ∼70% were Europe-based studies. Most data were from the first wave of the pandemic. PASC symptoms were analysed from 28 days after hospital discharge. At 1-4 months post-acute SARS-CoV-2 infection, the most frequent individual symptoms were fatigue (29.3% (95% CI 20.1-40.6%)) and dyspnoea (19.6% (95% CI 12.8-28.7%)). Many patients experienced at least one symptom at 4-8 months (73.1% (95% CI 44.2-90.3%)) and 8-12 months (75.0% (95% CI 56.4-87.4%)). CONCLUSIONS A wide spectrum of persistent PASC-associated symptoms were reported over the 1-year follow-up period in a significant proportion of participants. Further research is needed to better define PASC duration and determine whether factors such as disease severity, vaccination and treatments have an impact on PASC.
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Affiliation(s)
- J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | | | | | - Zarena Jafry
- Costello Medical Consulting, Inc., Boston, MA, USA
| | | | - Mark Berry
- Gilead Sciences Europe Ltd, Uxbridge, UK
| | | | - Linda Chen
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Jennifer K Quint
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
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6
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Stefani L, Brown P, Gerges M, Emerson P, Ferkh A, Kairaitis K, Gilroy N, Altman M, Thomas L. Echocardiographic Assessment in Patients Recovered from Acute COVID-19 Illness. J Cardiovasc Dev Dis 2023; 10:349. [PMID: 37623362 PMCID: PMC10456092 DOI: 10.3390/jcdd10080349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
Coronavirus (COVID-19) infections have spread rapidly worldwide and posed an immense public health problem. COVID-19 infection can affect the cardiovascular system both acutely and in patients followed up some period after COVID-19 infection. The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by echocardiography in COVID-19 recovered patients (hospitalized and non-hospitalized). Forty-two patients who recovered from COVID-19 but had ongoing symptoms were included in this retrospective observational cross-sectional study. Patients were followed-up at a median time of 112 days from confirmed COVID-19 diagnosis and a comprehensive echocardiogram was performed. COVID-19 patients were age- and sex-matched to healthy controls. Traditional TTE parameters and advanced echocardiographic parameters including two-dimensional LV global longitudinal strain (GLS) and RV free wall strain (FWS) were measured. LV volumes and LV ejection fraction were similar in COVID-19 patients and controls; however, LV GLS was significantly worse in the COVID-19 group (p = 0.002). Similarly, RV volumes and traditional RV function parameters were similar, but RV FWS (p = 0.009) and RV global strain (p = 0.015) were reduced. Alterations in LV and RV strain were observed in both hospitalized and non-hospitalized patients. In the subset of COVID-19 patients without any co-morbidities (n = 30), LV GLS remained reduced compared to controls. According to multivariate analysis, COVID-19 infection was the only independent determinant of reduced LV GLS (p = 0.012), while COVID-19 infection, diastolic blood pressure, and RV fractional area change were determinants of RV FWS. In this observational study, prior COVID-19 infection demonstrated LV dysfunction in patients with persistent symptoms. Abnormal LV strain was evident in both hospitalized and non-hospitalized patients, suggesting that these changes are independent of the severity of COVID-19 infection at presentation. The use of LV GLS in COVID-19 patients could have potential clinical utility to support the indication for cardiac magnetic resonance imaging in patients with possible COVID-19 related myocarditis. Future longitudinal studies are needed to evaluate its correlation with adverse cardiovascular events.
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Affiliation(s)
- Luke Stefani
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Paula Brown
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Monica Gerges
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Peter Emerson
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Aaisha Ferkh
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Kristina Kairaitis
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead 2145, Australia
| | - Nicole Gilroy
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Department of Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Mikhail Altman
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Liza Thomas
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
- Southwestern Clinical School, University of New South Wales, Kensington 2052, Australia
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Vera-Pineda R, Carrizales-Sepúlveda EF, Morales-Rendón EJ, Ordaz-Farías A, Solís JG, Benavides-González MA, Flores-Ramírez R. Echocardiographic manifestations during the first 3 months after an episode of COVID-19 and their relationship with disease severity and persistence of symptoms. Am J Med Sci 2023; 366:32-37. [PMID: 37040829 PMCID: PMC10082966 DOI: 10.1016/j.amjms.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Cardiovascular manifestations in patients with COVID-19 are associated with dire outcomes. Long COVID syndrome is the persistence of symptoms after acute disease and is found in up to 40% of subjects. There is little information regarding subacute echocardiographic manifestations after COVID-19, and no study has included a Mexican mestizo population. METHODS This cross-sectional study included subjects older than 18 with an episode of COVID-19 in the last 3 months. Those with previously known cardiovascular disease were excluded. The patient´s medical history and COVID-19 information were obtained from clinical charts. We performed a transthoracic echocardiogram in every subject and determined left ventricular (LV) index mass, LV ejection fraction (LVEF), left ventricular global longitudinal strain (LV GLS), right ventricular (RV) GLS, and tricuspid annular plane systolic excursion (TAPSE). A descriptive and comparative analysis was performed based on symptom severity and persistence. RESULTS One hundred subjects were included; 63% were classified with mild and 37% with moderate to severe COVID-19. The median of LVEF was 60% (55-60), LV GLS and RV GLS was impaired in 34% and 74% of patients, respectively. Patients with moderate to severe disease had significantly lower LVEF (Mean Difference: -3.3), TAPSE (mean difference: -1.8), and higher (worse) LV GLS (Mean Difference: 2.5) and RV GLS (mean difference: 2.9). Persistent symptoms were associated with lower TAPSE and higher RVGLS. CONCLUSIONS Patients who recover from COVID-19 have a high prevalence of subtle RV and LV dysfunction using GLS analysis. A moderate to severe episode was associated with worse RV and LV function measured by RV GLS, TAPSE, and LV GLS. Subjects with persistent symptoms had worse RVGLS and TAPSE.
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Affiliation(s)
- Raymundo Vera-Pineda
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; Division of Interventional Cardiology, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Edgar Francisco Carrizales-Sepúlveda
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; Heart Failure Unit, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Eliu Jefte Morales-Rendón
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; Division of Interventional Cardiology, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Alejandro Ordaz-Farías
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; Echocardiography Laboratory, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - José Gabriel Solís
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | | | - Ramiro Flores-Ramírez
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; Echocardiography Laboratory, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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8
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Leitman M, Fuchs S, Tyomkin V, Hadanny A, Zilberman-Itskovich S, Efrati S. The effect of hyperbaric oxygen therapy on myocardial function in post-COVID-19 syndrome patients: a randomized controlled trial. Sci Rep 2023; 13:9473. [PMID: 37301934 PMCID: PMC10257166 DOI: 10.1038/s41598-023-36570-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
Post-COVID-19 condition refers to a range of persisting physical, neurocognitive, and neuropsychological symptoms following SARS-CoV-2 infection. Recent evidence revealed that post-COVID-19 syndrome patients may suffer from cardiac dysfunction and are at increased risk for a broad range of cardiovascular disorders. This randomized, sham-control, double-blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on the cardiac function of post-COVID-19 patients with ongoing symptoms for at least three months after confirmed infection. Sixty patients were randomized to receive 40 daily HBOT or sham sessions. They underwent echocardiography at baseline and 1-3 weeks after the last protocol session. Twenty-nine (48.3%) patients had reduced global longitudinal strain (GLS) at baseline. Of them, 13 (43.3%) and 16 (53.3%) were allocated to the sham and HBOT groups, respectively. Compared to the sham group, GLS significantly increased following HBOT (- 17.8 ± 1.1 to - 20.2 ± 1.0, p = 0.0001), with a significant group-by-time interaction (p = 0.041). In conclusion, post-COVID-19 syndrome patients despite normal EF often have subclinical left ventricular dysfunction that is characterized by mildly reduced GLS. HBOT promotes left ventricular systolic function recovery in patients suffering from post COVID-19 condition. Further studies are needed to optimize patient selection and evaluate long-term outcomes.This study was registered with ClinicalTrials.gov, number NCT04647656 on 01/12/2020.
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Affiliation(s)
- Marina Leitman
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shmuel Fuchs
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Tyomkin
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Zilberman-Itskovich
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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9
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O'Mahoney LL, Routen A, Gillies C, Ekezie W, Welford A, Zhang A, Karamchandani U, Simms-Williams N, Cassambai S, Ardavani A, Wilkinson TJ, Hawthorne G, Curtis F, Kingsnorth AP, Almaqhawi A, Ward T, Ayoubkhani D, Banerjee A, Calvert M, Shafran R, Stephenson T, Sterne J, Ward H, Evans RA, Zaccardi F, Wright S, Khunti K. Corrigendum to "The prevalence and long-term health effects of long Covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis". EClinicalMedicine 2023; 59:101959. [PMID: 37096187 PMCID: PMC10115131 DOI: 10.1016/j.eclinm.2023.101959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.eclinm.2022.101762.].
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Affiliation(s)
| | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Anneka Welford
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alexa Zhang
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Urvi Karamchandani
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | | | - Shabana Cassambai
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Ashkon Ardavani
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Grace Hawthorne
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ffion Curtis
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Andrew P Kingsnorth
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Thomas Ward
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Daniel Ayoubkhani
- Office for National Statistics, Government Buildings, Newport, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Amitava Banerjee
- Faculty of Population Health Sciences, Institute of Health Informatics, University College London, London, UK
- Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre and NIHR Applied Research Collaboration West Midlands, University Hospital Birmingham and University of Birmingham, Birmingham, UK
- NIHR Leicester Biomedical Research Centre, Respiratory Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation and Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jonathan Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Helen Ward
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Respiratory Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- Office for National Statistics, Government Buildings, Newport, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
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10
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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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11
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Kersten J, Schellenberg J, Jerg A, Kirsten J, Persch H, Liu Y, Steinacker JM. Strain Echocardiography in Acute COVID-19 and Post-COVID Syndrome: More than Just a Snapshot. Biomedicines 2023; 11:biomedicines11041236. [PMID: 37189854 DOI: 10.3390/biomedicines11041236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Speckle-tracking echocardiography (STE) has become an established, widely available diagnostic method in the past few years, making its value clear in cases of COVID-19 and the further course of the disease, including post-COVID syndrome. Since the beginning of the pandemic, many studies have been published on the use of STE in this condition, enabling, on the one hand, a better understanding of myocardial involvement in COVID-19 and, on the other, a better identification of risk to patients, although some questions remain unanswered in regard to specific pathomechanisms, especially in post-COVID patients. This review takes a closer look at current findings and potential future developments by summarising the extant data on the use of STE, with a focus on left and right ventricular longitudinal strain.
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Affiliation(s)
- Johannes Kersten
- Division for Sports and Rehabilitation Medicine, University Hospital of Ulm, 89075 Ulm, Germany
| | - Jana Schellenberg
- Division for Sports and Rehabilitation Medicine, University Hospital of Ulm, 89075 Ulm, Germany
| | - Achim Jerg
- Division for Sports and Rehabilitation Medicine, University Hospital of Ulm, 89075 Ulm, Germany
| | - Johannes Kirsten
- Division for Sports and Rehabilitation Medicine, University Hospital of Ulm, 89075 Ulm, Germany
| | - Hasema Persch
- Division for Sports and Rehabilitation Medicine, University Hospital of Ulm, 89075 Ulm, Germany
| | - Yuefei Liu
- Division for Sports and Rehabilitation Medicine, University Hospital of Ulm, 89075 Ulm, Germany
| | - Jürgen M Steinacker
- Division for Sports and Rehabilitation Medicine, University Hospital of Ulm, 89075 Ulm, Germany
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12
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Cecchetto A, Torreggiani G, Guarnieri G, Vianello A, Baroni G, Palermo C, Bertagna De Marchi L, Lorenzoni G, Bartolotta P, Bertaglia E, Donato F, Aruta P, Iliceto S, Mele D. Subclinical Myocardial Injury in Patients Recovered from COVID-19 Pneumonia: Predictors and Longitudinal Assessment. J Cardiovasc Dev Dis 2023; 10:jcdd10040179. [PMID: 37103058 PMCID: PMC10144016 DOI: 10.3390/jcdd10040179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
(1) Background: Emerging data regarding patients recovered from COVID-19 are reported in the literature, but cardiac sequelae have not yet been clarified. To quickly detect any cardiac involvement at follow-up, the aims of the research were to identify: elements at admission predisposing subclinical myocardial injury at follow up; the relationship between subclinical myocardial injury and multiparametric evaluation at follow-up; and subclinical myocardial injury longitudinal evolution. (2) Methods and Results: A total of 229 consecutive patients hospitalised for moderate to severe COVID-19 pneumonia were initially enrolled, of which 225 were available for follow-up. All patients underwent a first follow-up visit, which included a clinical evaluation, a laboratory test, echocardiography, a six-minute walking test (6MWT), and a pulmonary functional test. Of the 225 patients, 43 (19%) underwent a second follow-up visit. The median time to the first follow-up after discharge was 5 months, and the median time to the second follow-up after discharge was 12 months. Left ventricular global longitudinal strain (LVGLS) and right ventricular free wall strain (RVFWS) were reduced in 36% (n = 81) and 7.2% (n = 16) of the patients, respectively, at first the follow-up visit. LVGLS impairment showed correlations with patients of male gender (p 0.008, OR 2.32 (95% CI 1.24-4.42)), the presence of at least one cardiovascular risk factor (p < 0.001, OR 6.44 (95% CI 3.07-14.9)), and final oxygen saturation (p 0.002, OR 0.99 (95% CI 0.98-1)) for the 6MWTs. Subclinical myocardial dysfunction had not significantly improved at the 12-month follow-ups. (3) Conclusions: in patients recovered from COVID-19 pneumonia, left ventricular subclinical myocardial injury was related to cardiovascular risk factors and appeared stable during follow-up.
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Affiliation(s)
- Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Gianpaolo Torreggiani
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, University of Padua, 35128 Padua, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University of Padua, 35128 Padua, Italy
| | - Giulia Baroni
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Chiara Palermo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | | | - Giulia Lorenzoni
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Patrizia Bartolotta
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Emanuele Bertaglia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Filippo Donato
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Patrizia Aruta
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
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13
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ZeinElabdeen SG, Sherif A, Kandil NT, Altabib AMO, abdelrashid MA. Left atrial longitudinal strain analysis in long Covid-19 syndrome. Int J Cardiovasc Imaging 2023; 39:939-944. [PMID: 36786877 PMCID: PMC9927057 DOI: 10.1007/s10554-023-02801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/13/2023] [Indexed: 02/15/2023]
Abstract
It is known that during the active course of Coronavirus disease 2019 (COVID-19), myocardial injury has an established pathological base, while its myocardial injury post-recovery is still obscured.The aim of this study was to evaluate the longitudinal left atrial strain (LAS) using speckle tracking echocardiography (STE) in COVID-19-recovered patients who are previously healthy without confounder comorbidities to detect the potential cardiac dysfunction.200 patients were prospectively included and examined 4?12 weeks after recovery from COVID-19 infection. 137 participants with comorbidities or previous history of cardiopulmonary disease were excluded from the analysis. A total of 63 patients who fulfilled our inclusion criteria were recruited into two groups according to thepresence or absence of persistent dyspnoea and exercise intolerance. Clinical, laboratory & comprehensive echocardiographic examinations were done for all. We observed that 31.7% of the previously healthy individuals developed dyspnoea & exercise intolerance post-COVID-19 infection. There were significantly impaired LAS parameters in the symptomatic group (LA reservoir, contraction & conduit strain, 22.7%, -6.6% & -16.1% versus 40%, -12%, and ? 27% in the asymptomatic group with P < 0.000). Only LA reservoir strain and LA stiffness can independently predict the development of dyspnoea & exercise intolerance post-COVID-19 at cut-off values of 30% & 24.5% respectively with a sensitivity of 90% and a specificity of 91%, P < 0.001. These impaired LAS parameters could explain the developed symptoms post-COVID-19 recovery, even before disturbed conventional diastolic echocardiographic parameters.LAS parameters are significantly associated with the developed exertional dyspnoea & exercise intolerance post-COVID-19. LA reservoir strain & LA stiffness could provide a simple, easily available tool that points to early LV diastolic dysfunction and may direct the therapy in this subset of the population.
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Affiliation(s)
| | - Abdelsalam Sherif
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Talaat Kandil
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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14
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De A, Bansal M. Clinical profile and the extent of residual myocardial dysfunction among patients with previous coronavirus disease 2019. Int J Cardiovasc Imaging 2023; 39:887-894. [PMID: 36607468 PMCID: PMC9816519 DOI: 10.1007/s10554-022-02787-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Many patients who have recovered from their coronavirus disease 2019 (COVID-19) episode continue to remain symptomatic and seek medical opinion. The clinical characteristics and echocardiography findings of such subjects have not been adequately studied. METHODS The study included 472 subjects (age 54.0 ± 13.4 years, 57% men) with previous COVID-19 (median duration since COVID-19 12.0 weeks, interquartile range 9.0-26.0 weeks) and 100 controls (age 53.9 ± 13.6 years, 53% men). All subjects underwent detailed clinical assessment and echocardiography, including measurement of left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS). RESULTS Less than third (29.2%) of the post-COVID subjects had needed hospitalization for their initial infection. Exertional dyspnea or breathing difficulty at rest were the commonest reasons for post-COVID presentation. As compared to controls, the post-COVID subjects had impaired LV systolic (LVEF 63.2 ± 2.2 vs. 61.9 ± 4.6, P = 0.007; GLS - 19.9 ± 2.6% vs. -17.6 ± 3.4%, P < 0.001) and diastolic function. Majority of those with reduced LV GLS had preserved LVEF. The patients presenting before 12 weeks were more likely to be symptomatic, but LV GLS did not differ. The patients needing hospitalization had higher burden of co-morbidities and significantly reduced LV GLS as compared to those who had received domiciliary treatment. The patients in the lowest GLS tertile were older, had higher burden of co-morbidities, and had had more severe initial infection with greater need for hospitalization, oxygen therapy and steroids. The need for hospitalization was independently associated with lower GLS at the time of current presentation. CONCLUSION This study shows that impairment of LV systolic and diastolic function is common among subjects recovering from previous COVID-19 episode. The patients with more severe initial infection have more marked impairment of LV function and this impairment persists even after several months of recovery from the initial infection. Routine measurement of GLS may be helpful since LV systolic dysfunction in these patients is mostly subclinical.
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Affiliation(s)
- Aniruddha De
- Suraksha Diagnostics Private Limited, Kolkata, India ,Dept. of Non-invasive Cardiology, Apollo Multispecialty Hospitals, Kolkata, India
| | - Manish Bansal
- Clinical and Preventive Cardiology, Medanta Heart Institute, Medanta- The Medicity, 122001 Gurgaon, Haryana India
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15
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Sljivo A, Brigic L, Abdulkhaliq A, Dadic I, Reiter L, Sirucic I, Abdulkadir M, Mulac A. Echocardiographic Findings of Covid-19 Patients in Canton Sarajevo During the Third Wave of the Covid-19 Pandemic. Mater Sociomed 2023; 35:290-294. [PMID: 38380286 PMCID: PMC10875953 DOI: 10.5455/msm.2023.35.290-294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024] Open
Abstract
Background Increasing evidence indicates that COVID-19 may result in cardiac issues in certain individuals, such as myocarditis, arrhythmias, and heart failure. Ongoing research on echocardiographic manifestations is still limited. Objective To investigate the incidence and patterns of left and right ventricular dysfunction in COVID-19 patients. Methods This study retrospectively observed COVID-19 patients admitted to the Clinical Center of University of Sarajevo during the third wave, with a particular focus on cardiac evaluations. Results Our patients, predominantely male 155 (72.4%), with a mean age of 66.2±11.4, having hypertension 86 (40.1%), diabetes mellitus 61 (28.5%), hyperlipidemia 144 (67.3%), were active smokers 87 (40.6%), had family history of cardiovascular diseases 123 (57.5%) and were COVID-19 positive 95 (44.4%), presented because of chest pain 78 (36.4%), dyspnea 103 (48.1%), palpitations 67 (31.3%), fatigue 106 (49.5%) and peripheral oedema 30 (14.0%). COVID-19 patients reported much higher symptoms of dyspnea (65 (68.4%) vs 38 (31.9%)) and fatigue (73 (76.8%) vs 33 (27.7%)) than COVID-19 negative patients. On the initial laboratory report, COVID-19 patients had a significantly (p<0.05) higher mean score of C-reactive protein (24.0±4.8 vs. 6.0±2.1), D-dimer (1.6±2.5 vs 0.8±0.6), ALT (94.8±17.2 vs 36.5±19.9) and creatinine (128.0±80.8 vs. 93.4±40.1) when compared to COVID-19 negative patients. COVID-19 patients had enlarged left atrium diametes (31.6±5.6 vs 27.5±5.3), enlarged left ventricular diameter both in systole (27.9±18.1 vs 23.3±16.3) and diastole (39.3±24.1 vs 34.9±22.7), reduced left ventricular ejection fraction (53.5±9.2 vs 59.8±4.3) and elevated right ventricular systolic pressure (37.0±16.4 vs 35.1±8.6). Conclusion COVID-19 patients had enlarged left atrium, enlarged systolic and diastolic left ventricular diameter, reduced left ventricular ejection fraction and elevated right ventricular systolic pressure.
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Affiliation(s)
- Armin Sljivo
- Clinical Center University of Sarajevo, University of Sarajevo, Bosnia and Herzegovina
| | - Lejla Brigic
- Clinical Center University of Sarajevo, University of Sarajevo, Bosnia and Herzegovina
| | - Arian Abdulkhaliq
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Ilma Dadic
- Dom Zdravlja Sarajevo, Bosna and Herzegovina
| | - Leopold Reiter
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Iman Sirucic
- Clinical Center University of Sarajevo, University of Sarajevo, Bosnia and Herzegovina
| | - Mohammed Abdulkadir
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Ahmed Mulac
- Clinical Center University of Sarajevo, University of Sarajevo, Bosnia and Herzegovina
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16
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Oikonomou E, Lampsas S, Theofilis P, Souvaliotis N, Papamikroulis GA, Katsarou O, Kalogeras K, Pantelidis P, Papaioannou TG, Tsatsaragkou A, Marinos G, Siasos G, Tousoulis D, Vavuranakis M. Impaired left ventricular deformation and ventricular-arterial coupling in post-COVID-19: association with autonomic dysregulation. Heart Vessels 2023; 38:381-393. [PMID: 36169708 PMCID: PMC9516516 DOI: 10.1007/s00380-022-02180-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/22/2022] [Indexed: 02/07/2023]
Abstract
Coronavirus disease-19 (COVID-19) has extended implications namely the long COVID-19 syndrome. We assessed over-time changes in left ventricular (LV) function, aortic stiffness, autonomic function, and ventricular-arterial coupling (VAC) in post-COVID-19 patients. We followed 34 post-COVID-19 subjects, up to 6 months post-hospital discharge. Subjects without COVID-19 served as control. We evaluated LV global longitudinal strain (LV-GLS), arterial stiffness [carotid-femoral pulse wave velocity (cf-PWV)], and heart rate variability -standard deviation of normal RR intervals (SDNN). VAC was estimated as the ratio of cf-PWV to LV-GLS. Post-COVID-19 individuals (1-month post-hospital discharge) presented with impaired LV-GLS [-18.4%(3.1) vs. -22.0%(2.7), P < 0.001], cf-PWV [12.1 m/s (3.2) vs. 9.6 m/s (1.9), P < 0.001], SDNN [111.3 ms (22.6) vs. 147.2 ms (14.0), P < 0.001], and VAC [-0.68 (0.22) vs. -0.44 (0.10), P < 0.001] compared to control. LV-GLS, SDNN, and VAC improved at the 6-month follow-up however they did not reach control levels. In post-COVID-19 subjects, SDNN and VAC were correlated at the 1-month (R = 0.499, P = 0.003) and 6-month (R = 0.372, P = 0.04) follow-up. Long COVID-19 syndrome was associated with impaired LV-GLS, SDNN, and VAC. Post-COVID-19 subjects presented with autonomic dysregulation associated with aortic stiffness, ventricular-arterial impairment, and LV dysfunction, even 6-months post-hospital discharge. These abnormalities may be related to the presence of long COVID-19 syndrome.
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Affiliation(s)
- Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece ,1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Nektarios Souvaliotis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece
| | - George Aggelos Papamikroulis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece
| | - Ourania Katsarou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece ,1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece
| | - Theodore G. Papaioannou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece
| | - Aikaterini Tsatsaragkou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece
| | - Georgios Marinos
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece ,Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Dimitris Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Mesogeion 152, 11527 Athens, Greece ,1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
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17
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Boparai MS, Musheyev B, Khan U, Koduru T, Hinson J, Skopicki HA, Duong TQ. Cardiac Magnetic Resonance Imaging of COVID-19-Associated Cardiac Sequelae: A Systematic Review. Rev Cardiovasc Med 2022; 23:389. [PMID: 39076661 PMCID: PMC11270474 DOI: 10.31083/j.rcm2312389] [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: 08/04/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 07/31/2024] Open
Abstract
Background Many COVID-19 survivors experience persistent COVID-19 related cardiac abnormalities weeks to months after recovery from acute SARS-CoV-2 infection. Non-invasive cardiac magnetic resonance (CMR) imaging is an important tool of choice for clinical diagnosis of cardiac dysfunctions. In this systematic review, we analyzed the CMR findings and biomarkers of COVID-19 related cardiac sequela after SARS-CoV-2 infection. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), we conducted a systematic review of studies that assessed COVID-19 related cardiac abnormalities using cardiovascular magnetic resonance imaging. A total of 21 cross-sectional, case-control, and cohort studies were included in the analyses. Results Ten studies reported CMR results < 3 months after SARS-CoV-2 infection and 11 studies > 3 months after SARS-CoV-2 infection. Abnormal T1, abnormal T2, elevated extracellular volume, late gadolinium enhancement and myocarditis was reported less frequently in the > 3-month studies. Eight studies reported an association between biomarkers and CMR findings. Elevated troponin was associated with CMR pathology in 5/6 studies, C-reactive protein in 3/5 studies, N-terminal pro-brain natriuretic peptide in 1/2 studies, and lactate dehydrogenase and D-dimer in a single study. The rate of myocarditis via CMR was 18% (154/868) across all studies. Most SARS-CoV-2 associated CMR abnormalities resolved over time. Conclusions There were CMR abnormalities associated with SARS-CoV-2 infection and most abnormalities resolved over time. A panel of cardiac injury and inflammatory biomarkers could be useful in identifying patients who are likely to present with abnormal CMR pathology after COVID-19. Multiple mechanisms are likely responsible for COVID-19 induced cardiac abnormalities.
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Affiliation(s)
- Montek S Boparai
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Benjamin Musheyev
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Umair Khan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Tejaswi Koduru
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Jared Hinson
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Hal A Skopicki
- Department of Medicine, Division of Cardiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Tim Q Duong
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
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18
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Bürgi JJ, Rösslein M, Nolte O, Wick P, Garcia Boy R, Stranders S, Dollenmaier G, Peier K, Nohynek B, Fischer A, Stolz R, Cettuzzi M, Graf L, Korte W. Mild COVID-19 induces early, quantifiable, persistent troponin I elevations in elder men. Front Cardiovasc Med 2022; 9:1053790. [DOI: 10.3389/fcvm.2022.1053790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
ImportanceElderly patients, especially men, are at risk of increased morbidity from coronavirus disease 2019 (COVID-19). Long-term data on troponin I levels in longitudinal observational studies of outpatients with mild to moderate COVID-19 are scarce.ObjectiveThis controlled cohort study aimed to evaluate the course of troponin I concentrations over a long period in convalescent COVID-19 outpatients with mild to moderate symptoms.Setting and participantsIn this cohort study, individuals with PCR-confirmed, mild to moderate SARS-CoV-2 infection as well as control individuals with confirmed negative PCR and negative SARS-CoV-2 serology were included. Study visits were performed from April 2020 through July 2021 (initialized during the first wave of the corona pandemic in Switzerland). A study visit in patients comprised blood draws every week in the first month and additionally after 8 weeks. This course was repeated in patients observed long-term.ResultsThis study enrolled 278 individuals from the Canton of St. Gallen, Switzerland, aged 12–92 years (59.5% women), who had mild to moderate COVID-19 symptoms (outpatients only) and a diagnosis confirmed by positive RT-PCR. Fifty-four of the participants with confirmed SARS-CoV-2 infection were followed for 14 months with repeat cycles of the testing protocol. In addition, 115 symptomatic patients that were PCR and serology negative were enrolled in the same time period as a control group. In COVID-19 patients, low-level troponin I concentrations (cTnI) were significantly increased from baseline until week 9 after positive RT-PCR diagnosis in men older than 54 years [ΔcTnI = 5.0 ng/L (median); 95% CI 4.1–6.0; p = 0.02]. The troponin I concentration remained elevated throughout 14 months in men older than 54 years within the cohort with a prolonged observation period. This statistically significant change in troponin I concentration was not dependent on co-morbidities in this group. ALT, Creatinine, BNP, and D-Dimer values after convalescence did not differ in comparison to the control cohort.ConclusionIn this analysis of individuals with confirmed SARS-CoV-2 infection, hs troponin I levels of men aged 54 or older significantly increased after infection. They remained elevated for at least 14 months after diagnosis. This suggests the possibility of an ongoing, long-term, low-grade myocardial injury. Further studies with focus on elderly patients and a prolonged observational period are necessary to elucidate whether the phenomenon observed is associated with detectable structural changes to the heart muscle or is without further clinical consequences.
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Bhattacharyya P. Unsuspected Subclinical Left Ventricular Dysfunction in Post-COVID Patients: A Real-world Observation. JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2022. [DOI: 10.5005/japi-11001-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Kunal S, Bagarhatta P, Palleda GM, Bansal A, Batra V, Daga MK, Tyagi S, Sharma A, Bansal K, Agarwal R, Gupta MD. Role of cardiovascular magnetic resonance imaging in COVID-19 recovered patients: A short-term follow-up study. Echocardiography 2022; 39:1401-1411. [PMID: 36266740 PMCID: PMC9874707 DOI: 10.1111/echo.15466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/26/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Cardiac involvement in recovered COVID-19 patients assessed by cardiac magnetic resonance imaging (MRI). METHODS Subjects recently recovered from COVID-19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30-90 days following recovery from COVID-19) with a follow-up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). RESULTS All the 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID-19-recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID-19 [3/4;75%]). Subjects with severe COVID-19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p < .0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p = .04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. CONCLUSIONS An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one-fourth at 6 months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long-term cardiovascular sequelae. COVID-19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution.
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Affiliation(s)
- Shekhar Kunal
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | | | - Girish M. Palleda
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Ankit Bansal
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Vishal Batra
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Mradul K. Daga
- Department of MedicineMaulana Azad Medical CollegeDelhiIndia
| | - Sanjay Tyagi
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Ashok Sharma
- Department of RadiodiagnosisGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Kalpana Bansal
- Department of RadiodiagnosisGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Ritu Agarwal
- Department of RadiodiagnosisEternal Heart Care Center (EHCC)JaipurRajasthanIndia
| | - Mohit D. Gupta
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
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Thiele K, Balfanz P, Müller T, Hartmann B, Spiesshoefer J, Grebe J, Müller-Wieland D, Marx N, Dreher M, Daher A. Cardiopulmonary work up of patients with and without fatigue 6 months after COVID-19. Sci Rep 2022; 12:18038. [PMID: 36302947 PMCID: PMC9607837 DOI: 10.1038/s41598-022-22876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
The pathogenesis of long-Covid symptoms remains incompletely understood. Therefore, we aimed to determine cardiopulmonary limitations 6 months after surviving COVID-19 using pulmonary function tests, echocardiographic studies to the point of analysis of global-longitudinal-strain (GLS), which describes the cycling myocardium deformation and provides better data on left ventricular (LV) dysfunction than LV ejection fraction (LVEF), and validated questionnaires. Overall, 60 consecutive hospitalized patients were included (61 ± 2 years, 40% treated in the ICU). At follow-up (194 ± 3 days after discharge), fatigue was the most prevalent symptom (28%). Patients with fatigue were more symptomatic overall and characterized by worse quality of life (QoL) scores compared to patients without fatigue (all p < 0.05), mainly due to limited mobility and high symptom burden. While PFT variables and LVEF were normal in the vast majority of patients (LVEF = 52% (45-52%)), GLS was significantly reduced (- 15% (- 18 to - 14%)). However, GLS values were not different between patients with and without fatigue. In conclusion, fatigue was the most prevalent long-Covid symptom in our cohort, which was associated with worse QoL mainly due to limited mobility and the high burden of concomitant symptoms. Patients showed a subtle myocardial dysfunction 6 months after surviving COVID-19, but this did not relate to the presence of fatigue.
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Affiliation(s)
- Kirsten Thiele
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Paul Balfanz
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Tobias Müller
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Bojan Hartmann
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Jens Spiesshoefer
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Julian Grebe
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Dirk Müller-Wieland
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Nikolaus Marx
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Michael Dreher
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Ayham Daher
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
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22
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Nuzzi V, Del Mestre E, Degrassi A, Bromage DI, Manca P, Piper S, Artico J, Gentile P, Scott PA, Chiatto M, Merlo M, Pareek N, Giacca M, Sinagra G, McDonagh TA, Cannata A. Cardiovascular Damage in COVID-19: What We Know Two Years Later. Curr Cardiol Rep 2022; 24:1085-1091. [PMID: 35751835 PMCID: PMC9244358 DOI: 10.1007/s11886-022-01730-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF THE REVIEW The Coronavirus disease 2019 (COVID-19) pandemic has profoundly influenced cardiological clinical and basic research in the past two years. In the present review, we summarize the current knowledge on myocardial involvement in COVID-19, providing an overview on the incidence, the pathogenetic mechanisms, and the clinical implications of cardiac injury in this setting. RECENT FINDINGS The possibility of heart involvement in patients with COVID-19 has received great attention since the beginning of the pandemic. After more than two years, several steps have been taken in understanding the mechanisms and the incidence of cardiac injury during COVID-19 infection. Similarly, studies globally have clarified the implications of co-existing heart disease and COVID-19. Severe COVID-19 infection may be complicated by myocardial injury. To date, a direct damage from the virus has not been demonstrated. The presence of myocardial injury should be systematically assessed for a prognostication purpose and for possible therapeutic implications.
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Affiliation(s)
- Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Eva Del Mestre
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Degrassi
- Department of Emergency Medicine, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), Friuli-Venezia Giulia, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Paolo Manca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Susan Piper
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Jessica Artico
- Institute of Cardiovascular Science, Barts Heart Centre, Barts Health NHS Trust, University College London, West Smithfield, London, UK
| | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paul A Scott
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Mario Chiatto
- UOC di Cardiologia UTIC, Ospedale Civile dell'Annunziata, Cosenza, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Nilesh Pareek
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Mauro Giacca
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Theresa A McDonagh
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Antonio Cannata
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK.
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23
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Rácz G, Takács H, Kormányos Á, Polestyuk B, Borbás J, Gyenes N, Schvartz N, Németh G, Kincses ZT, Sepp R, Nagy V. Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities. Diagnostics (Basel) 2022; 12:diagnostics12081941. [PMID: 36010290 PMCID: PMC9406902 DOI: 10.3390/diagnostics12081941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 01/08/2023] Open
Abstract
Although the clinical manifestations of SARS-CoV-2 viral infection affect mainly the respiratory system, cardiac complications are common and are associated with increased morbidity and mortality. While echocardiographic alterations indicating myocardial involvement are widely reported in patients hospitalized for acute COVID-19 infection, much fewer data available in non-hospitalized, mildly symptomatic COVID-19 patients. In our work, we aimed to investigate subclinical cardiac alterations characterized by parameters provided by advanced echocardiographic techniques following mild SARS-CoV-2 viral infection. A total of 86 patients (30 males, age: 39.5 ± 13.0 yrs) were assessed 59 ± 33 days after mild SARS-CoV-2 viral infection (requiring no hospital or <5 days in-hospital treatment) by advanced echocardiographic examination including 2-dimensional (2D) speckle tracking echocardiography and non-invasive myocardial work analysis, and were compared to an age-and sex-matched control group. Altogether, variables from eleven echocardiographic categories representing morphological or functional echocardiographic parameters showed statistical difference between the post-COVID patient group and the control group. The magnitude of change was subtle or mild in the case of these parameters, ranging from 1−11.7% of relative change. Among the parameters, global longitudinal strain [−20.3 (−21.1−−19.0) vs. −19.1 (−20.4−−17.6) %; p = 0.0007], global myocardial work index [1975 (1789−2105) vs. 1829 (1656−2057) Hgmm%; p = 0.007] and right ventricular free wall strain values (−26.6 ± 3.80 vs. −23.8 ± 4.0%; p = 0.0003) showed the most significant differences between the two groups. Subclinical cardiac alterations are present following even mild SARS-CoV-2 viral infection. These more subtle alterations are difficult to detect by routine echocardiography. Extended protocols, involving speckle-tracking echocardiography, non-invasive measurement of cardiac hemodynamics, and possibly myocardial work are necessary for detection and adequate follow-up.
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Affiliation(s)
- Gergely Rácz
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Hedvig Takács
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Árpád Kormányos
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Bianka Polestyuk
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - János Borbás
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Nándor Gyenes
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Noémi Schvartz
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Gergely Németh
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | | | - Róbert Sepp
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-30-267-5845; Fax: +36-62-545-820
| | - Viktória Nagy
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
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24
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Young KA, Krishna H, Jain V, Hamza I, Scott CG, Pellikka PA, Villarraga HR. Serial Left and Right Ventricular Strain Analysis in Patients Recovered from COVID-19. J Am Soc Echocardiogr 2022; 35:1055-1063. [PMID: 35760277 PMCID: PMC9232260 DOI: 10.1016/j.echo.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Strain analysis of transthoracic echocardiography (TTE) is a sensitive tool to detect myocardial dysfunction in those affected by COVID-19. Consideration of pre-existing cardiovascular disease is important in detecting changes related to COVID-19. We sought to assess serial TTE changes in patients recovered from COVID-19 compared to baseline, pre-COVID-19 exams, with a focus on left and right ventricular longitudinal strain. METHODS In this retrospective review of serial TTEs in confirmed COVID-19 patients at Mayo Clinic sites, included patients had a TTE within 2 years prior to confirmed COVID-19 diagnosis and the first available outpatient TTE after diagnosis used as comparison. Patients with interval cardiac surgery, procedure, or device placement (n=9) were excluded. Biventricular strain was retrospectively performed on both echocardiograms. RESULTS Of 259 individuals, age 60±16 years, 47% female, and 88% Caucasian, post-COVID-19 TTEs were performed a median of 55 days (IQR 37-92) following diagnosis. No clinically significant TTE changes were noted, though left ventricular ejection fraction (LVEF) was higher (58% vs 57%, p=0.049) and tricuspid annulus plane systolic excursion lower (20 vs 21mm, p=0.046) following COVID-19. Baseline LV global longitudinal strain (LV GLS) and right ventricular free wall strain (RV FWS) were normal (-19.6% and -25.8%, respectively) and similar following COVID-19 (-19.6% and -25.7%, p=0.07 and 0.77, respectively). In the 74 inpatients, no significant change from baseline was seen for LV GLS (-19.4% vs -19.1%, p=0.62), RV FWS (-25.5% vs -25.0%, p=0.69), or LVEF (57% vs 57%, p=0.71). A significant worsening in strain occurred in 27 patients, 16 (6.8%) of the 237 with LV GLS and 14 (6.0%) of the 235 with RV FWS. Ten (20%) patients reporting new symptoms following COVID-19 had worsened strain, compared to 5 (7%) with persistent/progressive symptoms and 11 (9%) with no new symptoms (p=0.04). CONCLUSIONS While patients with new symptoms following COVID-19 were more likely to have a worsening in absolute strain values, no clinically significant change in TTE parameters was evident in most patients following COVID-19 regardless of symptom status.
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Affiliation(s)
- Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hema Krishna
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vaibhav Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Izhan Hamza
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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25
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Yaroslavskaya EI, Krinochkin DV, Shirokov NE, Gorbatenko EA, Krinochkina IR, Gultyaeva EP, Korovina IO, Osokina NA, Garanina VD, Melnikov NN, Pomogaybo YI, Petelina TI. Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge. KARDIOLOGIIA 2022; 62:13-23. [PMID: 35168529 DOI: 10.18087/cardio.2022.1.n1859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Abstract
Aim To study changes in clinical and echocardiographic parameters in patients after documented COVID-19 pneumonia at 3 months and one year following discharge from the hospital. Material and methods The study included 116 patients who have had documented COVID-19 pneumonia. Patients underwent a comprehensive clinical evaluation at 3 months ± 2 weeks (visit 1) and at one year ± 3 weeks after discharge from the hospital (visit 2). Mean age of the patients was 49.0±14.4 years (from 19 to 84 years); 49.6 % were women. Parameters of global and segmentary longitudinal left ventricular (LV) myocardial strain were studied with the optimal quality of visualization during visit 1 in 99 patients and during visit 2 in 80 patients.Results During the follow-up period, the incidence rate of cardiovascular diseases (CVD) increased primarily due to development of arterial hypertension (AH) (58.6 vs. 64.7 %, р=0.039) and chronic heart failure (CHF) (35.3% vs. 40.5 %, р=0.031). Echocardiography (EchoCG) showed decreases in values of end-diastolic dimension and volume, LV end-systolic and stroke volumes (25.1±2.6 vs. 24.5±2.2 mm /m2, p<0.001; 49.3±11.3 vs. 46.9±9.9 ml /m2, p=0.008; 16.0±5.6 vs. 14.4±4.1 ml /m2, p=0.001; 36.7±12.8 vs. 30.8±8.1 ml /m2, p<0.001, respectively). LV external short-axis area (37.1 [36.6-42.0] vs. 38.7 [35.2-43.1] cm2, р=0.001) and LV myocardial mass index calculated with the area-length formula (70.0 [60.8-84.0] vs. 75.4 [68.2-84.9] g /m², р=0.024) increased. LV early diastolic filling velocity (76.7±17.9 vs. 72.3±16.0 cm /sec, р=0.001) and lateral and septal early diastolic mitral annular velocities decreased (12,10±3,9 vs. 11.5±4.1 cm /sec, р=0.004 and 9.9±3.3 vs. 8.6±3.0 cm /sec, р<0.001, respectively). The following parameters of LV global longitudinal (-20.3±2.2 vs. -19.4±2.7 %, р=0.001) and segmental strain were impaired: apical segments (anterior, from -22.3±5.0 to -20.8±5.2 %, р=0.006; inferior, from -24.6±4.9 to -22.7±4.6, р=0.003; lateral, from -22.7±4.5 to -20.4±4.8 %, р<0.001; septal, from -25.3±4.2 to -23.1±4.4 %, р<0.001; apical, from -23.7±4.1 to -21.8±4.1 %, р<0.001), mid-cavity (anteroseptal, from -21.1±3.3 to -20.4±4.1 %, р=0.039; inferior, from -21.0±2.7 to -20.0±2.9 %, р=0.039; lateral, from -18.4±3.7 to -17.6±4.4 %, р=0.021). RV basal and mid-cavity sphericity indexes increased (0.44±0.07 vs. 0.49±0.07 and 0.37±0.07 vs. 0.41±0.07, respectively, р<0.001 for both). A tendency for increased calculated pulmonary arterial systolic pressure (22.5±7.1 and 23.3±6.3 mm Hg, р=0.076) was observed. Right ventricular outflow tract velocity integral decreased (18.1±4.0 vs. 16.4±3.7 cm, р<0.001).Conclusion Patients after COVID-19 pneumonia one year after discharge from the hospital, compared to the follow-up data 3 months after the discharge, had an increased incidence of CVD, primarily due to the development of AH and CHF. EchoCG revealed changes in ventricular geometry associated with impairment of LV diastolic and systolic function evident as decreases in LV global longitudinal strain and LV myocardial apical and partially mid-cavity strain.
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Affiliation(s)
- E I Yaroslavskaya
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | - D V Krinochkin
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | - N E Shirokov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | - E A Gorbatenko
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | - I R Krinochkina
- Tyumen State Medical University, Tyumen, Russia City Clinical Hospital #1, Tyumen, Russia
| | - E P Gultyaeva
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | | | - N A Osokina
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | - V D Garanina
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | | | - Yu I Pomogaybo
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
| | - T I Petelina
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia
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26
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Saeed S, Rajani R. Subclinical myocardial dysfunction in patients following coronavirus disease 2019 infection. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:25-27. [PMID: 35043445 DOI: 10.1002/jcu.23101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ronak Rajani
- Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Özyildiz A, Ergül E, Emlek N, Özyildiz A, Duman H, Çetin M. Effect of coronavirus disease-2019 infection on left atrial functions. J Cardiovasc Echogr 2022; 32:89-94. [PMID: 36249439 PMCID: PMC9558639 DOI: 10.4103/jcecho.jcecho_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/16/2022] [Accepted: 03/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Left atrial (LA) dysfunction is a crucial risk factor for cardiovascular events, and various pathologies may affect LA function. Coronavirus disease-2019 (COVID-19) is an ongoing global pandemic causing morbidity and mortality. In the present study, we aimed to evaluate LA functions in patients who recovered from COVID-19. Methods: Sixty consecutive patients recovered from COVID-19 and 60 healthy individuals as a control group were included in the study. Blood samples and echocardiography measurements were obtained from each subject. The two groups were compared in terms of demographic and echocardiographic characteristics. Results: In the COVİD-19 group, LA maximum volume (LAVmax) (P = 0.040), LA pre-A volume (LAVpre-A) (P = 0.014), and LA active emptying fraction (P = 0.027) were higher, while LA passive emptying fraction (P = 0.035) was lower. In addition, left ventricular ejection fraction (P = 0.006) and isovolumetric relaxation time (P = 0.008) were decreased in this group. Although LA volume index was higher in the COVID-19 group, it does not reach statistical significance. Conclusion: LA functions may be impaired in patients recovered from COVID-19 infection.
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