ABSTRACT
Background: The COVID-19 disease is a multisystem disease due to in part to the vascular endothelium injury. Lasting effects and long-term sequalae could persist after the infection and may be due to persistent endothelial dysfunction. Purpose: Our study focused on the study of endothelial function measurement by digital thermal monitoring (DTM) of endothelial quality index with E4 diagnosis Polymath in a large cohort of long COVID-19 patients to determine whether long COVID-19 symptoms are due to endothelial dysfunction. Methods: This is a prospective multicenter longitudinal observational cohort study. Endothelial function was evaluated with “E4-Diagnose” Polymath Tunisia based on the Endothelium Quality Index (EQI). A complete echocardiographic evaluation analysis was performed. Primary outcomes were defined as the occurrence of long COVID-19 symptoms in patients with endothelial dysfunction measured by EQI. Results: A total of 798 patients were included in this study. Patients were included at an average time of 68.93 ± 43.1 days. The mean EQI was 2.02 ± 0.99 [0–5]. A total of 397 (49.7%) patients had poor or very poor EQI and 211 (26.4%) patients had very poor EQI. The median age was 49.94 ± 14.2 (18–80) years. A total of 618 patients (77.4%) had long COVID-19 symptoms. Patients with long COVID-19 symptoms had a reduced EQI (1.99 ± 0.97 vs. 2.09 ± 1.05, P = 0.24). Among long COVID-19 symptoms, fatigue was the most common symptom reported in 42.2%. Fatigue and chest pain were significantly associated to the endothelial dysfunction (P = 0.04 and 0.001 respectively). Patients with chest pain had significantly lower EQI (1.74 ± 1.0 vs. 2.09 ± 0.9, P ≤ 10−3) and LVGLS (−16.35 ± 3.0 vs. −17.16 ± 2.5, P = 0.04). Conclusion: Long COVID-19 symptoms specifically chest pain and fatigue are due to persistent poor endothelial quality index. These findings allow a better care of patients with long COVID-19 symptoms.
ABSTRACT
Background Several protocols are in study to understand mechanisms of these persistent symptoms of COVID-19. The conventional echocardiography can be a good tool to detect abnormalities in the cardiovascular system induced by long COVID-19. Objective Correlation between echocardiographic parameters and symptoms of long COVID and the spontaneous evolution at one month of follow-up. Patients and methods A prospective multicentric study including a total of 630 patients diagnosed with COVID-19, 2weeks to one month after recovering from COVID-19. Young patients without any medical history other than recent SARS-CoV2 infection are selected. A meticulous interrogation and clinical examination as well as an echocardiography are performed in all of patients. In addition to symptoms, we assessed echocardiographic parameters including initial left ventricular global longitudinal strain (initial SLG: SLGi) and after one month (SLG control: SLGc). Results Mean SLGi was −18.1±2.4 in study group (−19.6±1.5;P<0.001). Forty-two patients (52.5%) had initially altered strain versus 38 patients (47.5%) with normal strain. The threshold value for SLG in our study has been established using ROC curve which was −17.95% with sensibility (52.5%) and specificity (83.7%). we found a statistically significative correlation between the initial alteration of SLG and persistent symptoms in multivariate test: dyspnea (P<0.002);chest pain (P=0.031). At one month of follow-up, 87.5% of patients improved their SLG. And there was a correlation between control GS value (mean SLGc was −18.91±3.33;P=0.002) associated with a marked improvement in symptoms (P=0.001). Conclusion We reported here an original case series of SLG alteration induced by SARS-CoV2 infection that is correlated with the presence of chest pain and dyspnea. However, this affection seems to be spontaneously significantly reversible and associated with significant clinical improvement.