Cardiovascular status and echocardiographic changes in survivors of COVID-19 pneumonia three months after hospital discharge

Coronavirus disease 2019 (COVID-19) affects the function of all organs and systems. Today, studying the effect of COVID-19 on cardiovascular system, including on echocardiographic characteristics, is relevant. Aim. To study the prevalence of symptoms, cardiovascular disease and changes in echocardiographic data in persons after documented COVID-19 pneumonia 3 months after discharge from the hospital. Material and methods. The study included 106 patients after documented COVID-19 pneumonia. The patients underwent a comprehensive examination during hospitalization and 3 months+/-2 weeks after discharge from the hospital. The mean age of participants was 47+/-16 years (19-84 years);49% of subjects were women. Results. Three months after hospital discharge, the symptoms persisted in 86% of examined patients. There were significant echocardiographic changes as follows: a decrease in LV end-diastolic, end-systolic and stroke volume (113,8+/-26,8 ml vs 93,5+/-29,4 ml;37,7+/-13,0 ml vs 31,3+/-14,2 ml;77,2+/-17,8 ml vs 62,2+/-18,7 ml, respectively, p<0,001 for all). The right ventricular anteroposterior dimension and the pulmonary trunk diameter decreased over time (26,0 [24,0-29,3] mm vs 25,0 [23,0-27,0] mm, p=0,004;21,7+/-3,6 mm vs 18,7+/-2,5 mm, p<0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] ml vs 31,0 [22,0-36,5] ml, p<0,001) and maximum width (36,1+/-4,6 mm vs 34,5+/-6,5 mm, p=0,023) decreased, while the right atrial maximum length increased (46,7+/-6,8 mm vs 48,6+/-7,1 mm, p=0,021). Conclusion. In survivors of COVID-19 pneumonia three months after hospital discharge, complaints persisted in 86% of cases. Cardiovascular diseases were detected in 52% of participants, including hypertension in 48,1% and coronary artery disease in 15,1%. Compared with in-hospital data, the echocardiographic characteristics improved, which was expressed mainly in a decrease in right heart load. Copyright © 2021, Silicea-Poligraf. All rights reserved.

Prospective analysis of laboratory blood parameters in patients with cardiovascular diseases who underwent COVID-19-associated pneumonia.

The study of the characteristics and dynamics of laboratory biomarkers in patients with cardiovascular diseases (CVD) undergoing COVID-19-associated pneumonia may be of great clinical importance. The study included 116 patients who underwent COVID-19-associated pneumonia. The patients were divided into 2 groups. The first group included 49 patients without CVD, the second group - 67 patients with CVD. A blood sample was performed in all patients at the time of hospitalization and 3 months after discharge from the hospital. The parameters of general blood count, biochemistry, hemostasis, and biomarkers of inflammation were assessed - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine and IL-6. All patients initially underwent computed tomography of the chest organs. We found that ESR, WBC (leukocytes), NLR (neutrophils/lymphocytes ratio), fibrinogen, LDH (lactate dehydrogenase), LYM/CRP ratio (lymphocytes/CRP) were parameters that significantly distinguished patients in the 1st and 2nd groups. Three months after discharge from the hospital in patients of both groups the increased indicators approached the reference values, however, some parameters such as CRP, ESR, WBC, fibrinogen remained at a higher level in group 2 compared to group 1. Correlation analysis revealed the relationship between parameters of inflammation and hemostasis in the 2nd group of patients, which confirms the presence of latent vascular inflammatory potential in this group. It was revealed that such indicators as lymphocytes, neutrophils, APTT and LDH were associated with the initial volume of lung lesion more than 50%. Increase of these parameters by 1 unit contributes to increase in the volume of lung tissue damage by 6.5%, 6.4%, 11%, and 0.6%, respectively. Thus, dynamic control of laboratory parameters has prognostic value in assessing the nature of the course of COVID-19 associated pneumonia in patients with CVD and developing an algorithm for personalized monitoring of patients in the post-COVID period with the aim of timely correction of therapy to prevent unwanted vascular complications.

Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge.

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.

Estimation of erythrocyte parameters of general blood analysis in patients with SARS-CoV-2 -associated pneumonia.

The study of the features and dynamics of the erythrocyte parameters of general blood analysis in patients with cardiovascular diseases who underwent SARS-CoV-2 associated pneumonia is of great practical importance. That was a prospective study. The study included 106 patients with SARS-CoV-2-associated pneumonia. All patients were divided into 2 groups. The first group included 51 patients without CVD, the second group included 55 patients with CVD .Patients in both groups underwent laboratory examination of blood samples at the time of hospitalization and 3 months after discharge from the hospital. Parameters of the erythroid series of the general blood test were assessed. Among inflammatory biomarkers, we examined the concentration of C-reactive protein (CRP), high-sensitivity CRP (hs-CRP) and homocysteine. Initially all patients underwent computed tomography of the chest organs. Revealed what indicators of the erythroid series in the groups of patients with and without CVD had significant differences in a number of parameters: ESR; RDW-SD and RDW-CV with significant excess of parameters in group 2. Three months after discharge from the hospital, patients in both groups had a significant increase in HCT, MCV, MCH. There was detected decrease in both groups in MCHC, RDW-CV (p<0.001 for all parameters), ESR level in group 2.At baseline, CRP exceeded reference values in both groups of patients, reaching maximum values in group 2. After 3 months CRP decreased significantly only in group 1. Increased CRP was associated with elevated hs-CRP in 3 months after discharge and elevated homocysteine levels in both groups, indicating the persistence of prolonged inflammatory vascular reaction in patients after SARS-CoV-2 associated pneumonia, more pronounced in group 2 patients. RDW-CV over 13.6 and lymphocytes / CRP less than 0.6 increase the likelihood of having lung tissue damage over 50% by 9.3 and 5.9 times, respectively. Thus, the data obtained confirm that RDW-CV, the coefficient of variation of erythrocyte distribution width, associated with the parameters of inflammatory response and the lymphocytes / CRP is lung volume marker and of COVID-19 severity. Careful consideration of already known laboratory parameters allows us to expand the number of indicators influencing the risk of COVID-19 complications and enable an earlier response to a difficult situation.

Echocardiographic characteristics of covid-19 pneumonia survivors three months after hospital discharge

Coronavirus disease 2019 (COVID-19) is an infectious disease that affects almost all organs and systems. The main target is the respiratory system, but cardiovascular involvement is also common. Today, it is relevant to study the effect of complicated COVID-19 course on the patient’s cardiovascular system after hospital discharge — in particular, echocardiographic parameters. Aim. To study the echocardiographic parameters of patients with COVID-19 pneumonia 3 months after discharge from the hospital. Material and methods. The study included 106 patients with documented COVID-19 pneumonia. Patients underwent a comprehensive examination during hospitalization and 3 months ± 2 weeks after hospital discharge. The mean age of participants was 47±16 years (from 19 to 84 years), while 49% were women. Results. Three months after discharge, the average body mass index of the subjects was 28,2±5,7 kg/m2. Obesity was noted in 37,1%, cardiovascular diseases — in 52%. According to echocardiography, the prevalence of right ventricular (RV) dilatation was 2,9%, a decrease in tricuspid annular plane systolic excursion (TAPSE) — 9,5%, grade ≥2 tricuspid regurgitation — 1,9%, pulmonary hypertension (pulmonary artery systolic pressure >36 mm Hg) — 3,8%. The mean value of RV global longitudinal myocardial strain (GLMS RV) and global longitudinal myocardial strain (GLES RV) was 19,6±4,5 and 20,6±4,6, respectively. We found moderate correlations between GLMS RV and blood flow time through the left ventricular outflow tract (OT) (r=-0,436), through the mitral valve (r=-0,390;both p<0,0001) and through the RVOT (r=-0,348;р=0,004), with cardiac index (CI) (r=0,316;p=0,009), as well as between GLES RV and blood flow time through the LVOT (r=-0,411;p<0,0001) and RVOT (r=-0,300;p=0,005), and with CI (r=0,302;p=0,004). At the same time, the correlation of GLES RV with RV fractional area change (FAC) was weak (r=-0,283;p=0,007), while there was no correlation with the TAPSE. In addition, correlation of GLMS RV with these parameters were not defined. Conclusion. Three months after COVID-19 pneumonia, RV strain parameters were shown to have stronger relationships with time characteristics of flows in LVOT and RVOT, as well as with CI, than with such generally accepted characteristics of RV function as FAC and TAPSE.

Comparison of cardiovascular and psychological profile of young military men after covid-19 with and without pneumonia

Aim. To compare the cardiovascular and psychological profile of young military population after coronavirus disease 2019 (COVID-19) with/without pneumonia. Material and methods. We examined 26 military men under 30 years of age (22,3±3,7 years/21,0 [19,8;24,3] years) with documented COVID 19 (3 months±2 weeks after two virus-negative polymerase chain reaction tests). The participants were divided into 2 groups: experimental group (n=16) — those with COVID-19 pneumonia;comparison group (n=10) — those without pneumonia. All subjects underwent a complex of clinical and diagnostic tests. Results. Military men with COVID-19 pneumonia were significantly older (23,0 [20,5;28,5] years vs 19,5 [19,0;20,0] years, p=0,001). They had a prolonged PQ interval (154,5 [140,0;163,5] ms vs 137,0 [134,0;144,0] ms;p=0,014). According to echocardiography, the following parameters were significantly larger in experimental group: anteroposterior right ventricular dimension (26,0 [24,5;27,5] mm vs 23,5 [22,0;25,0] mm, p=0,012), right atrium length (48,0 [46,0;51,5] mm and 45,5 [44,0;47,0] mm, p=0,047), tricuspid regurgitation peak gradient (18,0 [15,5;22,0] mm vs 14,0 [12,0;20,0] mm, p=0,047), pulmonary artery systolic pressure (PASP) (30,3 [27,6;34,0] mm Hg vs 23,0 [20,5;30,5] mm Hg, p=0,038), mean pulmonary artery pressure (20,3 [18,9;22,7] mm Hg vs 16,8 [14,5;20,6] mm Hg, p=0,038). The estimated pulmonary vascular resistance was significantly higher in the study group (1,50 [1,2;1,8] Wood units vs 1,17 [1,1;1,2] Wood units, p<0,001). The groups did not differ significantly in terms of symptoms of stress (perceived stress scale score of 10) and anxiety and depression disorders (GAD7 and PHQ9 questionnaires), quality of life (SF-36 survey). Conclusion. In young military personnel, COVID-19 pneumonia in the long term after the disease is associated with longer PQ interval, older age and larger right heart sizes on echocardiography, as well as with a higher tricuspid regurgitation peak gradient, PASP, mean pulmonary artery pressure, and pulmonary vascular resistance. In this category of population, no association was found between the severity of COVID-19 and psychological status parameters.