Clinical and echocardiographic profile of patients one year after COVID-19 pneumonia depending on the left ventricular global longitudinal strain

Background. Studying the impact of complicated course of new coronavirus infection on the cardiovascular system in the long term after patient discharge from hospital is of high significance. Purpose. To compare the clinical and echocardiographic parameters of persons with history of verified COVID-19 pneumonia one year after discharge from hospital depending on the value of left ventricular (LV) global longitudinal strain (GLS). Material and Methods. A total of 116 patients (50.4% men) aged 49.0 ± 14.4 years (from 19 to 84 years) with history of verified COVID-19 pneumonia were examined one year ± three weeks after discharge. The parameters of left ventricular global and segmental longitudinal strain were studied in 80 patients with optimal quality of echocardiographic visualization. Patients were divided into groups depending on the LV GLS value: group 1 included 35 patients with normal LV GLS (<-20%);group 2 comprised 45 patients with impaired LV GLS (≥-20%). The groups did not differ in age (p = 0.145), severity of lung injury during hospitalization (p = 0.691), duration of hospitalization (p = 0.626), and frequency of stay in the intensive care unit (p = 0.420). Results. Abnormal values of LV GLS one year after discharge were found in 57.5% of patients with optimal visualization quality while the LV ejection fraction (EF) was normal in all patients. The majority of patients in group 2 were men (71.1% vs 28.6%, p < 0.001). A combination of coronary artery disease (CAD) and hypertension (AH) was more often diagnosed in this group (22% vs 6%, p = 0.040). The values of LV EF did not differ between the groups. The values of LV GLS were significantly worse in patients of group 2 (-17.6 ± 1.9% vs -21.8 ± 1.2%, p < 0.001). Moreover, the parameters of diastolic function including the left atrial emptying volume index (1.3 ± 0.3 mL/m2 vs 1.4 ± 0.3 mL/m2, р = 0.052) and velocity of the lateral part of the mitral valve fibrous ring e' (10.8 ± 4.4 cm/s vs 12.8 ± 4.0 cm/s, p = 0.045) were also lower in this group. Conclusions. The LV GLS was impaired in 57.5% patients with normal LV EF one year after COVID-19 pneumonia. In the group with impaired LV GLS, men predominated;coronary artery disease was more often detected in combination with AH;and parameters of LV diastolic function were worse compared with the corresponding parameters in the group of patients with normal LV GLS. © 2022 Tomsk State University. All rights reserved.

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.

One-year cardiac follow-up of COVID-19 pneumonia: dynamics of right heart echocardiographic parameters three months and one year after discharge

Funding Acknowledgements Type of funding sources: None. Background COVID-19 affects firstly the respiratory system, however the cardiovascular system is also damaged. To study the long-term effect of COVID-19 pneumonia on cardiovascular system, in particular on echocardiography (EchoCG) parameters of right heart is important for patients rehabilitation. Purpose To compare EchoCG parameters of right heart in patients with proven COVID-19 pneumonia 3 months and one year after discharge. Methods A total of 116 patients with confirmed COVID-19 pneumonia were included from April 2020 to July 2021. All patients underwent clinical examination including transthoracic EchoCG 3 months ±2 weeks and one year ±3 weeks after discharge. Mean age of patients was 49.0 ± 14.4 years (19-84 years), females were 49.6%. During hospitalization, chest computed tomography  (CT) detected mild lesions in 31.3%, moderate lesions in 33.3%, severe lesions in 29.3% and critical lesions in 6.1%. Results The rate of resolution of lung abnormalities according to CT was 55.9%. Mean body mass index was 28.7 ± 5.8 kg/m2 3 months after discharge, and it significantly increased to one year after discharge – 29.4 ± 6.1 kg/m2 (p < 0,001). The mean anteroposterior right ventricular (RV) diameter index decreased over the observation period (13.5 ± 1.9 vs 13.0 ± 1.5 mm/m2, p <0.001), as well as the indices of end-diastolic and end-systolic RV area (8.0 ± 1.8 vs 7.5 ± 1.5 cm2/m2 and 3.8 ± 1.1 vs 3.3 ± 0.8 cm2/m2, respectively, both p < 0.001). The basal RV diameter increased (30.4 ± 5.4 versus 31.1 ± 4.1 mm, p = 0.045), the mid-cavitary RV diameter did not change (25.8 ± 5.4 and 25.8 ± 4.2 mm, p = 0.852), and the base to apex RV length decreased (69.5 ± 8.8 vs 63.9 ± 8.3 mm, p < 0.001). Basal and mid RV sphericity indices (RVSI) increased (0.44 ± 0.07 vs 0.49 ± 0.07 and 0.37 ± 0.07 vs 0.41 ± 0.07, respectively, both p < 0.001). The systolic excursion of the fibrous ring of the tricuspid valve (TAPSE) (22.7 ± 3.2 and 22.8 ± 2.3 mm, p = 0.637) and the tricuspid annular peak systolic velocity S" did not change significantly (10.4 ± 2.6 and 10,1 ± 3.0 cm/s, p = 0.289). The fraction of change in the RV area (FAC RV) increased (52.6 ± 8.2 vs 55.0 ± 8.9%, p = 0.019). The right ventricular outflow tract velocity time integral (RVOT VTI) decreased (18.1 ± 4.0 vs 16.4 ± 3.7 cm, p < 0.001). There were tendencies to increase in the systolic pulmonary artery pressure (PAPs) (22.5 ± 7.1 and 23.3 ± 6.3 mm Hg, p = 0.076) and to increase of the right atrium (RA) long axis dimension (48.7 ± 6.5 vs 49.5 ± 6.3 mm, p = 0.074). Conclusions Compared to three months after discharge, in patients one year after COVID-19 pneumonia EchoCG showed the anteroposterior RV diameter and the end-diastolic RV area decreased, the FAC RV increased. However, increase of the basal and mid RVSI, decrease in the RVOT VTI and tendencies to increase of the PAPs and the RA long axis dimension was observed. A subgroup analysis is planned depending on the severity of lung damage during hospitalization.

Comparison of left heart echocardiographic parameters including strain in patients with COVID-19 pneumonia three months and one year after discharge

Funding Acknowledgements Type of funding sources: None. Background The long-term effect of a complicated course of COVID-19 on echocardiography (EchoCG) parameters, in particular on left heart, has not been sufficiently studied. Purpose To compare EchoCG parameters of left heart in patients with proven COVID-19 pneumonia 3 months and one year after discharge. Methods The patients were identified according to the data of the medical information system of the monohospital from April 2020 to July 2021 within the framework of "One-year Cardiac Follow-up of COVID-19 Pneumonia". A total of 116 men and women were included, mean age 49 ± 14.4 years, females 49.6%. During hospitalization, chest computed tomography detected mild lesions in 31.3%, moderate lesions in 33.3%, severe lesions in 29.3% and critical lesions in 6.1%. All patients underwent clinical examination including transthoracic EchoCG with 3 months ± 2 weeks and one year ± 3 weeks after discharge. All images were digitally stored and analyzed using off-line post processing with TomTec (Philips). The LV global and segmental longitudinal strain (LS) were studied in 100 individuals with satisfactory visualization quality 3 month after discharge and in 81 individuals one year after discharge. Results During the observation, the average body mass index of the subjects increased (28.7 ± 5.8 kg/m2 3 months after discharge vs 29.4 ± 6.1% one year after discharge, p < 0.001), as well as the rate of cardiovascular diseases (67% 3 months after discharge versus 79% one year after discharge, p = 0.008). Significant dynamics of mean left heart EchoCG parameters were observed. The mean index of left atrium (LA) maximal volume decreased (26.0 ± 7.2 vs 25.3 ± 7.4, p = 0.015), index of LA minimal volume increased (9.9 ± 5.4 vs 10.8 ± 5.6 ml/m2, p = 0.011). Left ventricular (LV) end-diastolic, end-systolic and stroke volume indexes decreased (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). The LV myocardial mass index increased (70.0 [60.8–84.0] vs 75.4 [68.2–84.9] g/m², p = 0.024). LV ejection fraction increased (68.1 ± 5.3 vs 69.7 ± 4.6%, p = 0.013). The LV global LS (-20.3 ± 2.2 vs -19.4 ± 2.7%, p = 0.001) and the LV segmental LS worsened: in mid segments (antero-septal -21.1 ± 3.3 vs -20.4 ± 4.1%, p = 0.039;inferior -21.0 ± 2.7 vs -20.0 ± 2.9%, p = 0.039;lateral -18.4 ± 3.7 vs -17.6 ± 4.4%, p = 0.021), and in apical segments (anterior -22.3 ± 5.0 vs -20.8 ± 5.2%, p = 0.006;inferior -24.6 ± 4.9 vs -22.7 ± 4.6, p = 0.003;lateral -22.7 ± 4.5 vs -20.4 ± 4.8%, p < 0.001;septal -25.3 ± 4.2 vs -23.1 ± 4,4%, p < 0.001;apical -23.7 ± 4.1 vs -21.8 ± 4.1%, p < 0.001). Conclusions Compared to 3 month after discharge, in patients one year after COVID-19 pneumonia the LA maximal volume, LV end-diastolic, end-systolic and stroke volumes decrease, and the LV ejection fraction increased. However, the LA minimal volume increased, and the LV global and segmental LS of the apical and mid LV segments worsened.

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.

Prospective analysis of inflammatory response markers, endothelial dysfunction and hemostasis parameters in COVID-19 associated pneumonia patients with and without type 2 diabetes mellitus

Background: The coronavirus disease 2019 (COVID-19) has spread around the world with high cardiovascular complications and mortality. Patients with heart pathology and diabetes mellitus were at greatest risk. An accurate and timely laboratory diagnosis is a vital step to help manage cardiovascular disease during this pandemic. Purpose: To conduct a prospective analysis of complete blood count parameters, inflammatory response, endothelial dysfunction of arterial wall and hemostasis in groups of patients undergoing COVID-19 associated pneumonia with and without type 2 diabetes mellitus (DM2);to highlight indicators of long-term adverse cardiovascular events. Methods: The study was carried out within register on one-year cardiac follow-up of patients after COVID-19-associated pneumonia. Patients (n=380) were identified in the period from April to July 2020 according to the data of medical information system of monoinfectious hospital. At the moment, data of the first 65 patients with cardiovascular pathology are obtained. Group 1 included 53 patients without DM2 (mean age 47.83±15.86 years), group 2 consisted of 12 patients with DM2 (61.71±9.12 years). Baseline parameters of complete blood count, biochemistry and hemostasis were assessed on the day of hospitalization. In-depth analysis of laboratory parameters was carried out in 3 months. Results: In group 1 significant decrease of coagulogram parameters: INR (p=0.004), fibrinogen, APTT, thrombocrit, large platelets level (p<0.0001), CRP level, liver enzymes (p<0.0001), leukocytes (p=0.015), erythrocytes (p=0.006) and increase in hematocrit (p<0.0001) were registered in 3 months compared to baseline data. In group 2 positive dynamics of CRP (p=0.018), platelets (p=0046), APTT (p=0.043) and erythrocytes (p=0.028) were revealed, while CRP concentration remained higher than reference values in 3 months. In group 2 in-depth analysis of biomarkers revealed values exceeding normal levels: hs-CRP (4.72±3.33 mg/L), homocysteine (13.17±7.95 μmol/L), myeloperoxidase (47.6±38.51), NT-proBNP (154.56±127.30 mg/ml), P-selectin (141.29±124.71) TgFb1 (6549.86±1987.87 pg/ml). Correlation analysis detected positive association of homocysteine level with platelets level (p=0.002. R=0.998), myeloperoxidase with fibrinogen (p=0.012. R=0.865). Conclusion: Three months after COVID-19 elevated levels of inflammatory markers (CRP, hs-CRP, homocysteine), endothelial dysfunction and thrombophilia (large platelets, P-selectin, TgFb1) are indicators of prolonged arterial inflammatory syndrome and increased predisposition to coagulopathy with thrombosis determining a very high risk of developing adverse cardiovascular events in patients with DM2.

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.