ABSTRACT
Background. The coronavirus pandemic has caused a rapid increase in the number of cases and high deaths worldwide. A new coronavirus infection in the presence of an initial cardiac pathology can provoke decompensation of chronic heart failure. Aim. To study the clinical features of postinfarction chronic heart failure occurring against the background of a new coronavirus infection. Material and methods. The study included 80 patients with decompensated chronic heart failure. Three groups have been formed. In patients of the first group (n=40), who underwent inpatient treatment for a new coronavirus infection, the cause of chronic heart failure was a previous Q-myocardial infarction. In patients of the second group (n=20), who did not tolerate COVID-19 earlier and at the time of the current hospitalization, the cause of chronic heart failure was a previous Q-myocardial infarction. The third group (n=20) consisted of patients with chronic heart failure of ischemic etiology without postinfarction cardiosclerosis, not previously and at the time of examination infected with the SARS-Cov-2 virus. Statistical analysis was carried out using the IBM SPSS Statistics V26 program. The Kolmogorov–Smirnov, Kruskal–Wallis, and Pearson χ2 tests were used. Results. Symptoms of left and right ventricular heart failure were equally common in all groups. Patients of the studied groups had a history of paroxysmal and permanent forms of atrial fibrillation, while the latter variant was more common in patients of the first group — with chronic heart failure with postinfarction cardiosclerosis and coronavirus infection. According to echocardiography, the most pronounced structural and functional changes in the myocardium were also found in patients of the first group with postinfarction heart failure and a new coronavirus infection. Thus, statistically significant differences related to the size of the left atrium, end diastolic volume and end systolic volume of the left ventricle, systolic pressure in the pulmonary artery. An increase in the end systolic volume of the left ventricle by 94.6% was registered in the first group compared with the third group of patients (p=0.001). Systolic pressure in the pulmonary artery in the first group was 14.2% higher than the normal values (p ≤0.001), while in patients of the second and third groups this indicator was within the normal range. Conclusion. In patients with postinfarction cardiosclerosis suffering from a new coronavirus infection, symptoms of chronic heart failure are more pronounced, characterized by a significant decrease in exercise tolerance;cardiac arrhythmias are more often recorded, and structural and functional changes in the myocardium are of a maladaptive nature. © Eco-Vector, 2023. All rights reserved.
ABSTRACT
Aim. To study the condition of the right heart and hepatolienal circulation in patients three months after COVID-19. Material and Methods. A total of 87 patients aged on average 36.2 years who were treated for COVID-19 three months before underwent echocardiography and the study of hepatolienal blood flow. Patients were divided into groups: group 1 comprised patients with CT 0;group 2 comprised patients with bilateral pneumonia CT 1-2, and group 3 comprised patients with CT 3-4. Control group comprised 22 patients who did not undergo COVID-19. Results. In patients of group 1, the diastolic velocity of the transtricuspid flow increased by 24% compared to the control p < 0.001. The ratio of diastolic velocities E/A and Em/Am decreased in all groups, and the greatest abnormalities were found in group 3. In group 3, systolic pressure in the pulmonary artery increased;the right ventricle, fibrous ring, right branch of the pulmonary artery, and diameters of the inferior vena cava, portal vein, and splenic veins increased. There was a decrease in the flow rate in the splenic vein (14%), and sizes of the liver and spleen increased. Correlations were established between increased pressure in the pulmonary artery and functional parameters of the heart and hepatolienal blood flow as well as between morpho-functional parameters of the heart and indicators of the portal vein, p < 0.001. Conclusion. Three months after the coronavirus infection, patients with mild and moderate severity of the disease developed subclinical abnormalities in the diastolic function of the right ventricle. In patients with severe viral pneumonia, there was also increased pressure in pulmonary artery;the dilatations of the right ventricle, pulmonary artery, splenic vein, and portal veins developed along with a decrease in the flow rate in the splenic vein and increases in the liver and spleen. © 2022 Tomsk State University. All rights reserved.
ABSTRACT
Aim. To study the myocardial morpho-functional abnormalities, the incidence and nature of cardiac arrhythmias in patients 3 months after the coronavirus disease 2019 (COVID-19). Material and methods. The study included 77 patients (mean age, 35,9 years) treated for coronavirus infection, which underwent echocardiography and 24-hour Holter monitoring 3 months after COVID-19. The patients were divided into 3 groups: group 1 — 31 patients with upper respiratory tract involvement;group 2 — 27 patients with bilateral pneumonia (CT grade 1, 2), 3 — 19 patients with severe pneumonia (CT grade 3, 4). Statistical processing was carried out using Statistica 10.0. Results. According to echocardiography, the peak tricuspid late diastolic velocity and isovolumetric contraction time in all groups increased (P<0,001). The tricuspid and mitral Em/Am ratio decreased depending on the disease severity. In group 3, the right ventricular and atrial size increased (P<0,001). The pulmonary artery systolic pressure, left atrial volume in patients of the 2nd and 3rd groups was higher than in the control one (P<0,001). In group 1 and 2 patients, the regional strain in basal and basal/middle segments decreased, respectively, while, in group 3, not only regional but also global left ventricular (LV) strain decreased (P<0,001). In all groups, cardiac arrhythmias and pericardial effusion were found. The relationship was established between coronavirus activity and the structural and functional myocardial parameters (P<0,001). Conclusion. Cardiovascular injury 3 months after COVID-19 was found in 71%, 93%, and 95% of patients with mild, moderate and severe course. In mild course patients, a decrease in regional myocardial strain in LV basal segments, signs of past pericarditis, and various cardiac arrhythmias were noted. In patients of moderate severity, these changes were more pronounced and were accompanied by an additional decrease in regional strain in LV middle segments, impaired right ventricular diastole and increased pulmonary artery pressure. In severe patients, in addition to the above changes, dilatation of the right heart and inferior vena cava was recorded, as well as LV diastolic and global systolic function decreased.