ABSTRACT
Background: Among many complications of coronavirus disease 2019 (COVID-19) there is a wide range of cardiovascular (CV) problems ranging from mild to severe ones. Even asymptomatic patients and those with mild course of COVID-19 may develop severe CV complications. Factors leading to such state have not been extensively studied so far. Purpose(s): We aimed to assess which factors were linked to the severe complications of COVID-19. Method(s): We included 200 consecutive patients admitted to the Department of Cardiology and Adult Congenital Heart Diseases of the Polish Mother's Memorial Research Institute (PMMHRI) due to post-Covid cardiovascular complications. SARS-CoV2 infection was confirmed with real-life PCR testing. Laboratory tests, 24-hour ECG monitoring and echocardiography were performed in all patients from the investigated group. For the purposes of our study severe complications were defined as: Myocarditis, a decrease of ejection fraction >10% from the pre-disease value, thromboembolic complications, angina pectoris requiring myocardial revascularization and the new onset of atrial fibrillation of supraventricular tachycardia. Some patients presented more than one of the above. Statistical analysis was performed using the software Statistica v.13 (TIBCO Software Inc., Palo Alto, CA, USA). Data were presented as mean +/-SD or median (25th- 75th percentile) for continuous variables and as proportions for categorical variables. Comparisons between groups were performed using Student's t-test for independent variables and the Mann-Whitney U test or chi2 test with Yates's correction, as appropriate. For all calculations p-values <0.05 were considered statistically significant. Result(s): Finally, we included 200 consecutive patients (aged 54+/-16 years, 76 males - 38%), hospitalized for COVID-19 complications after a median 3 (2-6) months following the acute phase of infection. On admission patients presented with dyspnea (23%), impairment of exercise tolerance (47%), chest pain (32%), increase in blood pressure (29%), palpitations (25%), weight loss (13%), brain fog (6%), general malaise (11%), headache (5%), limb pain (13%), swelling (14%). Severe complications of COVID-19 were diagnosed in 31 patients (16%).Taking into consideration symptoms, the presence of severe COVID-19 complications was significantly associated with dyspnoea and deterioration of exercise tolerance. In comparison to patients with mild complications, severe ones were linked to age (the older patients, the higher risk), previous history of heart failure and diabetes mellitus. We did not observe statistically significant differences in severity of complications depending on smoking status (Tables 1 and 2). Conclusion(s): Previous history of heart failure and diabetes mellitus as well as symptoms (dyspnoea and deterioration of exercise tolerance) along with older age are related to more severe complications following COVID- 19.
ABSTRACT
Background: Exercise intolerance de novo is one of the most common reported symptoms in patients (pts) recovering from COVID-19. Purpose(s): The present study determines etiological and pathophysiological factors influencing the mechanism of exercise intolerance in the COVID-19 survivors. Therefore, the factors affecting percent predicted oxygen uptake at peak exercise VO2 (%VO2pred) in pts after COVID-19 with normal left ventricular ejection fraction were assessed. Methods and Results: The 120 consecutive patients from the Department of Cardiology recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examinations, laboratory test results, echocardiography using Vivid E95 - GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), and spiroergometry using The MetaSoft Studio application were analysed. The subjects were divided into the two following groups: Study i.e. pts with worse oxygen uptake (%VO2pred <80%;N=47) and control including these cases with %VO2pred >=80% (N=73) - Table 1. Pts with %VO2pred <80% presented significantly lower global peak systolic strain (GLPS) [p=0.03], tricuspid annular plane systolic excursion (TAPSE) [p=0.002] and late diastolic filling velocity (A) [p=0.004] compared to controls - Figure 1. The male gender (p=0.007) and the percent of total body water content (TBW %) (p=0.02) were significantly higher in study in comparison to the control group. The results of multiple logistic regression model independently associated with %VO2pred were as follows: A (OR 0.4, 95% CI: 0.17-0.95;p=0.03) and gender (OR 2.52, 95% CI: 1.07-5.91;p=0.03). Conclusion(s): Males have over twice risk of persistent limited exercise tolerance after COVID-19 infection than females. The lower late diastolic filling velocity, tricuspid annular plane systolic excursion, worse global peak systolic strain, and hydration status are connected with limited exercise tolerance after COVID-19 in patients with normal left ventricular ejection fraction.
ABSTRACT
Background: Recent evidence has shown that patients with acute SARS-CoV-2 infection might present symptoms of infection a long time after a recovery. Purpose: To investigate the risk factors and assess the utility of spiroergometry parameters in differential diagnosing patients presenting the symptoms (dyspnea, fatique, pain in chest, muscle pain, cognitive impairment, taste and smell disturbances) persisting for a few months after recovery from COVID 19 (symptoms of long COVID). Methods and results: The 146 patients (pts) with normal left ventricular ejection fraction and without respiratory diseases, hospitalised in Cardiology Department recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examination, laboratory results, echocardiography using Vivid E95–GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), spiroergometry using The MetaSoft® Studio application were analyzed. The subjects were divided into the two following groups: group demonstrating long COVID symptoms (i.e. suffering from one of the following dyspnea, fatique, pain in chest, muscle pain, cognitive impairment, taste or smell disturbances) [N=44 pts] and the group without long COVID symptoms [N=102 pts]. Pts with long COVID symptoms presented significantly higher age (58 versus [vs] 44 years;p<0.0001), higher metabolic age (53 vs 45 years;p=0.01), higher left atrial diameter (37 vs 35 mm;p=0.04), higher left ventricular mass index (LVMI) (83 vs 74 g/m2, p=0.03), higher E/E' (7.3 vs 6;p<0.001) compared to control group. In CPET long COVID pts presented lower forced vital capacity (FVC) (3.6 vs 4.3 L;p=0.009), lower maximal oxygen consumption measured during incremental exercise indexed per kilogram (VO2max) (21 vs 23 ml/min/kg;p=0.04), lower respiratory exchange ratio (RER) (1.0 vs 1.1;p=0.04);lower forced expiratory volume in one second (FEV1) (2.9 vs 3.25 L;p=0,03);higher ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) (106 vs 100%;p=0.0002) – Figure 1, there were no significant changes in electrocardiogram between groups. The laboratory results pointed that pts with long COVID symptoms had also lower rate of red blood cells (RBC) (4,4 vs 4,6 mln;p=0.01);higher level of glucose (92 vs 90 mg%;p=0.02);lower glomerular filtration rate (GFR) estimate by Modification of Diet in Renal Disease (MDRD) (88 vs 95;p=0.02);higher level of hypersensitive cardiac Troponin T (hsTnT) (6.1 vs 3.9 ng/L;p=0.03). The parameters significant in univariate analyses were included to the multivariate model. The results of multiple logistic regression were as follows: age (OR 4.6, 95% CI: 1.7–11.5;p=0.001) and LVMI (OR 2.5, 95% CI: 1.0–6.6;p=0.04). Conclusions: Persistent symptoms in long COVID can mimic those of cardiovascular disease. Spiroergometric parameters are useful in making a proper diagnosis. Funding Acknowledgement: Type of funding sources: Public hospital(s). Main funding source(s): Polish Mother's Memorial Hospital Research InstituteFigure 1