Biventricular myocardial function in Covid-19 recovered patients assessed by speckle tracking echocardiography: a prospective cohort echocardiography study

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes respiratory disease and affects primarily the lungs, it may also lead to cardiovascular complications and late manifestations like myocarditis, arrhythmias and myocardial damage. Nevertheless, it is not clear whether cardiovascular involvement remains after Covid-19 recovery. Two-dimensional speckle tracking echocardiography (2D-STE) can detect subclinical myocardial dysfunction, if present, and has been widely used for left (LV) and right (RV) ventricular function assessment in several clinical conditions.

Purpose

The aim of our study was to evaluate prospectively myocardial systolic function and hence cardiac involvement in patients after the recovery from Covid-19, using 2D-STE.

Methods

100 Covid-19 recovered patients with preserved left ventricular ejection fraction (LVEF), were prospectively recruited from March 2021 until June 2021 at the General hospital of Korinthos and at the General hospital of Elefsina, "Thriassio". Based upon clinical manifestation of the disease, they were divided into two groups, those with mild symptoms, who were treated ambulant and those with respiratory insufficiency who were hospitalized. Conventional echo parameters as wells as LV global longitudinal strain (LVGLS), regional strain of all LV walls and right ventricular global longitudinal strain (RVGLS) were measured in all patients and compared to controls.

Results

The mean time of performed echo examination of all patients was 33.28 ± 9.4 days after the initial confirmed covid-19 infection diagnosis. Although overall LV systolic function expressed by EF was normal and similar to controls, LVGLS was found to be significantly lower in Covid-19 recovered patients in compare to controls (-18.47±-2.4 vs -21.07±-1.76% respectively, p < 0.0001). More specifically, it seemed that especially the lateral wall longitudinal strain (LATLS) and posterior wall longitudinal strain (POSTLS) were significantly reduced in all patients compared to controls (-17.77±-3.48 vs -20.97±-2.86% respectively, p < 0.0001 for LATLS and -19.52±-5.3 vs -22.23±-2.65% respectively, p = 0.01 for POSTLS). RVGLS was found significantly diminished only in the hospitalized group of Covid-19 recovered patients, compared to controls (-21.29±-5.58 vs -26.03±-4.55% respectively, p < 0.0001).

Conclusions

  LVGLS is affected in almost all individuals after covid-19 infection independently of the infection severity, with LATLS being the most sensitive marker of LV impairment and with POSTLS to follow. RV shows impaired GLS only in severely ill patients highlighting RVGLS as a helpful tool of prognosis. Recovered patients from Covid-19 infection have to be monitored for a long time, since the duration and evolution of these lesions is unknown, and the term "long covid disease" might also include the cardiac function.

Combination therapy as a potential risk factor for the development of type 2 diabetes in patients with schizophrenia: the GOMAP study

BACKGROUND

Schizophrenia (SCZ) is associated with increased risk of type 2 diabetes (T2D). The potential diabetogenic effect of concomitant application of psychotropic treatment classes in patients with SCZ has not yet been evaluated. The overarching goal of the Genetic Overlap between Metabolic and Psychiatric disease (GOMAP) study is to assess the effect of pharmacological, anthropometric, lifestyle and clinical measurements, helping elucidate the mechanisms underlying the aetiology of T2D.

METHODS

The GOMAP case-control study (Genetic Overlap between Metabolic and Psychiatric disease) includes hospitalized patients with SCZ, some of whom have T2D. We enrolled 1653 patients with SCZ; 611 with T2D and 1042 patients without T2D. This is the first study of SCZ and T2D comorbidity at this scale in the Greek population. We retrieved detailed information on first- and second-generation antipsychotics (FGA, SGA), antidepressants and mood stabilizers, applied as monotherapy, 2-drug combination, or as 3- or more drug combination. We assessed the effects of psychotropic medication, body mass index, duration of schizophrenia, number of hospitalizations and physical activity on risk of T2D. Using logistic regression, we calculated crude and adjusted odds ratios (OR) to identify associations between demographic factors and the psychiatric medications.

RESULTS

Patients with SCZ on a combination of at least three different classes of psychiatric drugs had a higher risk of T2D [OR 1.81 (95% CI 1.22-2.69); p = 0.003] compared to FGA alone therapy, after adjustment for age, BMI, sex, duration of SCZ and number of hospitalizations. We did not find evidence for an association of SGA use or the combination of drugs belonging to two different classes of psychiatric medications with increased risk of T2D [1.27 (0.84-1.93), p = 0.259 and 0.98 (0.71-1.35), p = 0.885, respectively] compared to FGA use.

CONCLUSIONS

We find an increased risk of T2D in patients with SCZ who take a combination of at least three different psychotropic medication classes compared to patients whose medication consists only of one or two classes of drugs.

Low-frequency and rare exome chip variants associate with fasting glucose and type 2 diabetes susceptibility

Fasting glucose and insulin are intermediate traits for type 2 diabetes. Here we explore the role of coding variation on these traits by analysis of variants on the HumanExome BeadChip in 60,564 non-diabetic individuals and in 16,491 T2D cases and 81,877 controls. We identify a novel association of a low-frequency nonsynonymous SNV in GLP1R (A316T; rs10305492; MAF=1.4%) with lower FG (β=-0.09±0.01 mmol l(-1), P=3.4 × 10(-12)), T2D risk (OR[95%CI]=0.86[0.76-0.96], P=0.010), early insulin secretion (β=-0.07±0.035 pmolinsulin mmolglucose(-1), P=0.048), but higher 2-h glucose (β=0.16±0.05 mmol l(-1), P=4.3 × 10(-4)). We identify a gene-based association with FG at G6PC2 (pSKAT=6.8 × 10(-6)) driven by four rare protein-coding SNVs (H177Y, Y207S, R283X and S324P). We identify rs651007 (MAF=20%) in the first intron of ABO at the putative promoter of an antisense lncRNA, associating with higher FG (β=0.02±0.004 mmol l(-1), P=1.3 × 10(-8)). Our approach identifies novel coding variant associations and extends the allelic spectrum of variation underlying diabetes-related quantitative traits and T2D susceptibility.