Mid-term subclinical myocardial injury detection in patients recovered from COVID-19 according pulmonary lesion severity (preprint)

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) may cause damage of the cardiovascular system during the acute phase of infection. However, Recent studies described a mid and long-term subtle cardiac injuries after recovery from acute Coronavirus disease 19 (COVID-19).The aim of this study was to determine the relationship between the severity of chest computed tomography (CT) lesions and the persistence of subtle myocardial injuries at mid-term follow-up of patients recovered from COVID-19 infection. Methods All COVID-19 patients were enrolled prospectively in this study. Sensitive troponin T (hsTnT) and chest CT scan was performed in all patients at the acute phase of Covid-19 infection. At the mid-term follow up, conventional transthoracic echocardiograph and global longitudinal strain (GLS) of left and right ventricles (LV and RV) were determined and compared between patients with chest CT scan lesions less than 50% (Group 1) and those with severe chest CT scan greater or equal to 50% (Group 2). Results The mean age was 55 more or less than 14 years. Both LV GLS and RV GLS were significantly decreased in the group 2 (p=0.013 and p=0.011, respectively). LV GLS value more than -18% was noted in 43% of all the patients and RV GLS value more than -20% was observed in 48% of them. The group with severe chest CT scan lesions included more patients with reduced LV GLS and reduced RV GLS than the group with mild chest CT scan lesions (G1:29% vs. G2:57%, p=0.002) and (G1:36% vs. G2:60 %, p=0.009) respectively). Conclusion Patients with severe chest CT scan lesions are more likely to develop subclinical myocardial damage. TTE could be recommended in patients recovering from COVID-19 to detect subtle LV and RV lesions. Trial registration The cohort of patients is a part of the research protocol (IORG 00093738 N°102/OMB 0990-0279) approved by the Hospital Ethics Committee.

Effect of vitamin D supplementation versus placebo on recovery delay among COVID-19 patients: A randomized-controlled clinical trial (preprint)

Introduction : The present study aimed to determine the impact of vitamin D supplementation on recovery delay among COVID-19 patients. Methods : We performed a randomized controlled clinical trial in the national center for COVID-19 confinement, from May to August 2020. Simple randomization was done in a 1:1 allocation ratio. We included patients aged more than 18 years who had confirmed RT PCR and who remained positive on the 14 th day. The intervention group received vitamin D supplementation (200,000 IU / 1 ml of Cholecalciferol), the control group received a placebo treatment (physiological saline (1 ml)). We measured the recovery delay and the E gene SARS-CoV-2 RT-PCR Cycle threshold (Ct) values. The Log rank test and Hazard ratios (HR) were calculated. Results : A total of 117 participants were enrolled. The mean age was 42.7 years (SD 14). Males represented 55.6%.The median duration of viral RNA conversion was 37 days ( 95% CI: 29-45.50) in intervention group and 28 days ( 95% CI: 23-39) in the placebo group (p=0.010). HR was 1.58 ( 95% CI: 1.09-2.29, p=0.015). Ct values revealed a stable trends over time in both groups. Conclusion : Vitamin D supplementation was not associated with a shortened recovery delay when given to patients for whom the RT-PCR remained positive on the 14th day. Trial registration: This study was approved by the Human Subjects Protection Tunisia center (TN2020-NAT-INS-40) on May 05, 2020 and by clinical trial.gov with approval number Clinical Trials.gov ID: NCT04883203.