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Objective. To assess the relationship between the severity of COVID-19 in patients without significant baseline cardiovascular pathology and various echocardiographic parameters of myocardial dysfunction. Material and methods. 46 patients with COVID-19 were included in our study: 33 patients of moderate severity and 13 - with severe disease. On days 1 and 9 upon admission, all patients underwent an echocardiographic study with standard assessment of the both ventricles function, as well as an assessment of their global longitudinal strain (GLS). Comparison of the studied parameters was carried out both between groups of patients and within each group in dynamics. Results. On day 1patients in the severe group had higher values of the systolic gradient on the tricuspid valve (22.0 [21.0;26.0] vs 30.0 [24.0;34.5] mm Hg, p = 0.02), systolic excursion of the plane of the tricuspid ring (2.3 [2.1;2.4] vs 2.0 [1.9;2.2] mm, p = 0.016), E/e' ratio (9.5 [7.7;8.9] vs 7.5 [6.8;9.3], p = 0.03). At day 9 among patients in the severe group, there was a decrease in end-diastolic (111.0 [100.0;120.0] vs 100.0 [89.0;105.0] ml, p = 0.03) and of end-systolic (35.5 [32.0;41, 2] vs 28.0 [25.0;31.8] ml, p < 0.01) volumes of the left ventricle. There was a decrease in GLS of the both ventricles compared to general accepted values. In dynamics, there was an increase in the GLS of the right ventricle in both groups, but it was more pronounced among severe group of patients (day 1 -18.5 [-15.2;-21.1] vs -20.2 [-15.8.1;-21.1] %, p = 0.03). The troponin levels were in the normal range. Conclusion. In COVID-19 patients without significant baseline cardiovascular pathology, there is a transient decrease in longitudinal strain of both ventricles, even in the absence of clinical and laboratory signs of acute myocardial injury.Copyright © Creative Cardiology 2021.
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The aim of this study was to investigate the presence of subclinical cardiac dysfunction in recovered coronavirus disease 2019 (COVID-19) patients, who were stratified according to a previous diagnosis of pulmonary embolism (PE) as a complication of COVID-19 pneumonia. Out of 68 patients with SARS-CoV-2 pneumonia followed up for one year, 44 patients (mean age 58.4 ± 13.3, 70% males) without known cardiopulmonary disease were divided in two groups (PE+ and PE-, each comprising 22 patients) and underwent clinical and transthoracic echocardiographic examination, including right-ventricle global longitudinal strain (RV-GLS), and RV free wall longitudinal strain (RV-FWLS). While no significant differences were found in the left- or right-heart chambers' dimensions between the two study groups, the PE+ patients showed a significant reduction in RV-GLS (-16.4 ± 2.9 vs. -21.6 ± 4.3%, p < 0.001) and RV-FWLS (-18.9 ± 4 vs. -24.6 ± 5.12%, p < 0.001) values compared to the PE- patients. According to the ROC-curve analysis, RV-FWLS < 21% was the best cut-off with which to predict PE diagnosis in patients after SARS-CoV-2 pneumonia (sensitivity 74%, specificity 89%, area under the curve = 0.819, p < 0.001). According to the multivariate logistic regression model, RV-FWLS < 21% was independently associated with PE (HR 34.96, 95% CI:3.24-377.09, p = 0.003) and obesity (HR 10.34, 95% CI:1.05-101.68, p = 0.045). In conclusion, in recovered COVID-19 patients with a history of PE+, there is a persistence of subclinical RV dysfunction one year after the acute phase of the disease, detectable by a significant impairment in RV-GLS and RV-FWLS. A reduction in RV-FWLS of lower than 21% is independently associated with COVID-related PE.
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Aim. To investigate the relationship between echocardiographic parameters and laboratory immune inflammation signs in patients after coronavirus disease 2019 (COVID-19) pneumonia depending on the left ventricular (LV) involvement according to speckle tracking echocardiography (STE). Material and methods. The study included 216 patients (men, 51,1%, mean age, 50,1+/-11,1 years). The examination was carried out in patients 3 months after COVID-19 pneumonia. Patients were divided in 3 groups: group I (n=41) - diffuse decrease (>=4 segments the same LV level) of longitudinal strain (LS) according to STE;group II (n=67) - patients with regional decrease (LS reduction >=3 segments corresponding to systems of the anterior, circumflex or right coronary arteries);group III - patients without visual left ventricle involvement (n=108). Results. There were no significant differences in LV ejection fraction - 68,9+/-4,1% in group I, 68,5+/-4,4% in group II and 68,6+/-4,3 in group III (p=0,934). A decrease in the global longitudinal left ventricle strain was detected significantly more often in groups I and II compared with group III (-17,8+/-2,0, -18,5+/-2,0 and -20,8+/-1,8%, respectively;p<0,001). At the same time, LS depression of LV basal level (-14,9+/-1,5, -16,8+/-1,2% and -19,1+/-1,7%;p<0,001), as well as a decrease in LS of LV inferior-posterior segments in group with diffuse involvement was detected significantly more often than in groups II and III. In addition, we revealed a significant difference in interleukin-6 concentration - 3,1 [2,5;4,0], 3,1 [2,4;3,8] and 2,5 [3,8;1,7] pg/ml, (p=0,033), C-reactive protein - 4,0 [2,2;7,9], 5,7 [3,2;7,9] and 2,4 [1,1;4,7] mg/l, (p<0,001), tumor necrosis factor-alpha - 5,9+/-1,9, 6,2+/-1,9 and 5,2+/-2,0 pg/ml, (p=0,004) and ferritin - 130,7 [56,5;220,0], 92,2 [26,0;129,4] and 51,0 [23,2;158,9] microg/l, respectively (p=0,025). Conclusion. A relationship was found between diffuse and regional left ventricular involvement according to STE and signs of immune inflammation in patients 3 months after COVID-19 pneumonia.Copyright © 2023 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.
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Background: The COVID-19 disease is known for its severe respiratory complications, however it was found to have some cardiovascular complication in post COVID-19 patients. The heart rate variability (HRV) is a non invasive, objective and reliable method for assessment of autonomic dysfunction in those recovered patients. Purpose(s): We aimed to evaluate the cardiac autonomic function by using valid HRV indices in subjects who recovered from mild to moderate acute COVID-19 but still symptomatic. Method(s): The study Group composed of 50 subjects with confirmed history of mild to moderate post COVID 19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 hours Holter monitoring for HRV analysis. Result(s): The mean age of the study population was 42+/-18 years, symptoms were reported as follows 27 (54%) had Dyspnea, 17 (34%) had palpitations, 7 (14%) had dizziness. Time domain parameters SDNN, SDANN and rMSSD were diminished with mean SDNN value being markedly impaired in 12 (24%) patient, while frequency domain parameters as assessed by LF/HF ratio with mean of 1.837 with 8% of patients being impaired. SDNN was significantly reduced in elderly patients (p=0.001), smokers (p=0.019) and hypertensive (p=0.016) and those complaining mainly of palpitation (p=0.006). SDNN was significantly reduced in patient with impaired LV diastolic function (p=0.009), in patients with reduced MAPSE (p=0.047), reduced TAPSE (p=0.00) and impaired Global longitudinal strain (0.000). Conclusion(s): Patients with post COVID-19 syndrome have abnormalities in the HRV which indicates some degree of dysfunction in the autonomic nervous system and consequently impaired parasympathetic function in this population, however this have been also correlating with subtle impairment of the left ventricular systolic function.We believe that this preliminary research can serve a starting point for future research in this direction.
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Background: Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac and pulmonary effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and possible long-term impairments after hospitalization because of Covid-19 infection as well as to try to identify predictors for Long-Covid. Method(s): This was a prospective, multicenter registry study. Patients with verified Covid-19 infection, who were treated as in-patients at our dedicated Covid hospital (Clinic Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During the study visit the following tests and investigations were performed: Detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), chest computed tomography (CT) scan, lung function test and a comprehensive list of laboratory parameters including cardiac bio markers. Result(s): Between July 2020 and October 2021, 150 patients were recruited. Sixty patients (40%) were female and the average age was 53.5+/-14.5 years. Of all patients, 92% had been admitted to our general ward and 8% had a severe course of disease, requiring admission to our intensive care unit. Six months after discharge the majority of patients still experienced symptoms and 75% fulfilled the criteria for Long-Covid. Only 24% were completely asymptomatic (figure 1). Echocardiography detected reduced global longitudinal strain (GLS) in 11%. Cardiac MRI revealed pericardial effusion in 18%. Furthermore, cardiac MRI showed signs of former peri-or myocarditis in 4%. Pulmonary CT scans identified post-infectious residues, such as bilateral ground glass opacities and fibrosis in 22%. Exertional dyspnea was associated with either reduced forced vital capacity measured during pulmonary function tests in 11%, with reduced GLS and/or diastolic dysfunction, thus providing evidence for a cardiac and/or pulmonary cause. Independent predictors for Long-Covid were markers of a more severe disease course like length of in-hospital stay, admission to an intensive care unit, type of ventilation as well as higher NT-proBNP and/or troponin levels. Conclusion(s): Even 6 months after recovery from Covid-19 infection, the majority of previously hospitalized patients still suffer from at least one symptom, such as chronic fatigue and/or exertional dyspnea. While there was no association between fatigue and cardiopulmonary abnormalities, impaired lung function, reduced GLS and/or diastolic dysfunction were significantly more prevalent in patients presenting with exertional dyspnea. On chest CT approximately one fifth of all patients showed post infectious changes in chest CT including evidence for myo-and pericarditis as well as accumulation of pericardial effusions.
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Background: Long COVID emerged as a new condition, following the acute episode of coronavirus disease 2019 (COVID-19),exerting a significant impact on patients' quality of life [1]. Several studies involving COVID- 19 survivors emphasized the presence of cardiac abnormalities following the acute infection. However, data on possible mechanisms associated to long COVID remain limited. Clinical applications of myocardial work (MW) analysis, assessed by transthoracic echocardiography (TTE) have expended recently, showing an additional value in detecting cardiac dysfunction compared to standard parameters such as left ventricle ejection fraction (LVEF) or global longitudinal strain (GLS) in various pathologies, including COVID-19 [2]. Nevertheless, its potential role in detecting subclinical cardiac dysfunction in long COVID remained unexplored. Purpose(s): We assessed the association between subclinical cardiac dysfunction evaluated by global work index (GWI) and global constructive work (GCW) and long COVID. Method(s): We included 310 COVID-19 patients hospitalized between March and April 2020. All patients were invited to a systematic one-year follow-up, including clinical evaluation, TTE with MW assessment, chestcomputed tomography and spirometry. 140 patients completed the followup. Normal values for GWI and GCW were defined as 1926+/-247 mmHg% and 2224+/-229 mmHg% [3]. The primary endpoint was long COVID, characterized by a cluster of symptoms such as fatigue or dyspnea more than 3 months after the acute infection, without any other explanation. Result(s): 140 patients (57.1+/-13.9 years, 90 (64.3%) males) had a mean follow-up of 337.1+/-34.5 days.The mean values of LVEF, GWI and GCW were 55.2+/-3.2%, 2105.9+/-403.3 mmHg% and 2377.8+/-446.2 mmHg%. 83 (61%) patients had long COVID. No significant differences in terms of comorbidities, clinical evaluation and COVID-19 severity were found between patients with and without long COVID. GCW (2276.7+/-410.3 vs 2516.5+/-458.6, p=0.006) and GWI (2008.5+/-358.9 vs 2242.2+/-427.0, p=0.003) were the only TTE parameters different between patients with and without long COVID. Multivariable regression analysis showed that GWI <1926 mmHg% (OR 6.095;CI: 2.024-18.355, p=0.001) and GCW <2224 mmHg% (OR 3.205;CI: 1.181-8.694, p=0.022) were the only MW parameters independently associated with long COVID, irrespective of age or the severity of the acute infection, at one year. In a subgroup analysis of 77 patients without previous cardiovascular diseases, long COVID was diagnosed in 45 (58.4%)patients. GWI <1926 mmHg% (OR 8.015;CI: 2.149-29.887, p=0.002) remained independently associated with long COVID at 1 year follow-up. Conclusion(s): Long COVID, frequently observed in recovered COVID-19 patients may indicate the presence of subclinical cardiac dysfunction, reflected by a decrease of the left ventricle performance, assessed by GWI and GCW.Long-term follow-up including cardiac screening should be performed in order to identify patients at risk who would benefit from cardiac rehabilitation programs.
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Introduction: Coronavirus disease 2019 (COVID-19) rapidly spread across the globe,evolving into a global pandemic,with a crucial impact on healthcare systems. Several short-term follow-up studies emphasized the persistence of symptoms, referred as long COVID, in a significant number of discharged patients even without history of cardiopulmonary diseases, with dyspnea being one of the most frequent complaint [1-3]. Even though those reports on recovered COVID-19 patients did not describe major left ventricle (LV) function abnormalities, subtle cardiac changes may be present. Purpose(s): We aimed to investigate the presence of subclinical cardiac dysfunction, assessed by transthoracic echocardiography (TTE) in recovered COVID-19 patients, without previous cardiopulmonary disease at 1 year follow-up. Method(s): 310 COVID-19 consecutive hospitalized patients were prospectively included between March and April 2020. 66 patients out of 251 recovered patients had no previous history of coronary artery disease, arrhythmia, arterial hypertension, valvular heart disease, asthma, chronic obstructive pulmonary disease and obstructive sleep apnea, respectively and were included in the final analysis (Figure 1). The follow-up consisted in 2 parts, a 6-months visit including clinical and physical examination, chest computed tomography and spirometry and a 12-months visit including clinical and physical examination, spirometry and TTE. Result(s): 66 patients (mean age 51.39+/-11.15 years, 45 (68.2%) males) were included in the final analysis. 23 (34.8%) patients reported dyspnea at 1 year. TTE parameters were in the normal range, with a mean LV ejection fraction of 56.9+/-4.6%, mean global longitudinal strain (GLS) of -20.9+/-2.3%, global constructive work (GCW) of 2381.4+/-463.6 mmHg% and global work index (GWI) of 2132.5+/-419.2 mmHg%. Type 1 diastolic dysfunction was observed in 11 (16.7%) patients. One (1.5%) patient had type 2 diastolic dysfunction. A normal respiratory pattern was reported in 31 (47%) patients at 6 months spirometry, while 19 (28.8%) patients had a restriction pattern. No significant differences regarding clinical, laboratory or imaging findings at baseline were found between groups. The following TTE parameters were significantly different in patients with and without dyspnea at 1 year: GLS (-19.97+/-2.14 vs. -21.38+/-2.37, p=0.039), GCW (2183.72+/-487.93 vs. 2483.14+/-422.42, p=0.024) and GWI (1960.06+/-396.21 vs. 2221.17+/-407.99, p=0.030). Multivariable logistic regression showed that GCW and GWI were inversely and independently associated with persistent dyspnea, one year after COVID-19 (p=0.035, OR 0.998, 95% CI 0.997-1.000;p=0.040, OR 0.998, 95% CI 0.997-1.000) (Table 1). Conclusion(s): Persistent dyspnea one year after COVID-19 was present in more than a third of patients without known cardiovascular or pulmonary diseases. GCW and GWI were the only echocardiographic parameters independently associated with symptoms, suggesting a decrease in myocardial performance in this population and subclinical cardiac dysfunction.
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Introduction: COVID-19 infection has been associated with acute myocardial dysfunction. However, long-term effects of myocardial injury during COVID-19 infection are not well characterized. Novel speckle tracking echocardiography (STE) may lend further insights into COVID-19 myocardial dysfunction. Method(s): Patients hospitalized with acute COVID-19 infection from March 2020 to September 2021 who underwent STE and had evidence of myocardial dysfunction (defined as left ventricular ejection fraction (LVEF) less than 55% and/or global longitudinal strain (GLS) less negative than -18%) were enrolled in follow-up 3-12 months after hospitalization. Clinical and laboratory data were collected, and follow-up STE was performed, including LVEF, GLS, myocardial work index (MWI) and myocardial work efficiency (MWE) measurements. Statistical analysis was performed to determine risk factors for worsening myocardial dysfunction at follow-up. Result(s): Twenty-four patients were enrolled at an average 239+/-102 days after the initial hospitalization echocardiogram: 13 (54%) male, 14 (58%) Black, and average age 56+/-14 years. Average duration of initial admission was 24+/-25 days;14 patients (58%) were admitted to the intensive care unit. Ten (42%) patients had acute respiratory distress syndrome, 1 (4%) had ST-elevation myocardial infarction and 1 (4%) had cardiac arrest. Eleven (46%) patients required mechanical ventilation and 2 (8%) required extracorporeal membrane oxygenation. Five (21%) patients had elevated troponin on admission and average peak troponin was 1.35+/-3.83 ng/ml. Follow-up STE showed significant improvement in average GLS (-13.7+/-3.2% vs -16.0+/-3.7%, P=0.03). There were no significant changes in average LVEF (55.9+/-12.6% vs 55.5+/-8.8%, P=0.90), MWI (1519+/-425 vs 1681+/-412, P=0.24) and MWE (93+/-4 vs 92+/-4, P=0.65) at follow-up compared to during COVID-19 infection. Patients with lower LVEF at follow-up as compared to acute infection (n=11, 46%) were more likely to have had longer duration of symptoms prior to initial presentation (11+/-5 days vs 6+/-5 days, P=0.02) and higher peak erythrocyte sedimentation rate (94+/-30 mm/h vs 44+/-36 mm/h, P=0.007) compared to those with stable or improved LVEF. Conclusion(s): Approximately 8 months after COVID-19 infection, average GLS was significantly improved in patients with myocardial dysfunction during acute COVID-19 infection. Close follow-up is recommended for patients with evidence of myocardial injury during COVID-19 infection, especially those who present with prolonged symptoms and those with high inflammatory markers.Copyright © 2022
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Introduction: The underlying pathophysiology of Post-COVID-19 syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus magnetic resonance spectroscopy (31P-MRS) allows noninvasive assessment of the myocardial energetic state. Purpose(s): We sought to assess whether Post-COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and tissue characteristics or energetic derangement. Method(s): Prospective case-control study. A total of 20 patients with a clinical diagnosis of Post-COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and ten matching controls underwent 31P-MRS and CMR at 3T at a single time point. (Figure 1) All patients had been symptomatic with acute COVID-19, but none required hospital admission. Result(s): Between the Post-COVID-19 syndrome patients and matched contemporary controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes, left ventricular mass), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 and extracellular volume [ECV] fraction mapping, late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with Post-COVID-19 syndrome showed subepicardial hyperenhancement on the late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, ECV, T1, T2 mapping or energetics. This patient was excluded from statistical analyses. (Table 1) Conclusion(s): In this study, the overwhelming majority of patients with a clinical Post-COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics.
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Background: The Coronavirus Disease 2019 (COVID-19) pandemic has transformed health systems worldwide. There is conflicting data regarding the degree of cardiovascular involvement following infection, generating uncertainty in patients and an additional healthcare burden with increased diagnostic testing. A registry was designed to evaluate the prevalence of echocardiographic abnormalities in Latin American adults recovered from COVID-19. Method(s): We prospectively evaluated 595 participants (mean age 45.5+/-14.9 years;50.8% female) from 10 institutions in Argentina and Brazil. Echocardiographic studies were conducted with General Electric equipment;2DE imaging and global longitudinal strain (GLS) of both ventricles were performed. Comparisons between groups were made with Chisquare, Fisher and Student's t-test. Logistic regression was performed to determine variables associated with abnormal echocardiogram findings. Result(s): A total of 61.7% of the participants denied any relevant cardiovascular medical history. Table 1 summarizes the comorbidities of the included patients. The majority of patients (82.5%) had the disease at home or in an out-of-hospital center. Of the patients who required hospitalization, 15.3% were in a general ward, 1.9% in intensive care and 0.3% required mechanical ventilation during the disease. The median time between infection and performance of the echocardiographic study was two months (IQR 1- 3 months). Among patients who reported symptoms following COVID-19 recovery (41.8%), the most frequently reported was dyspnea (47.4%), followed by mild symptoms such as asthenia, arterial hypertension or palpitations (32.9%), 12.9% referred chest pain, 6% of patients reported dyspnea and chest pain, and 0.8% reported various other symptoms. The mean left ventricular ejection fraction (LVEF) was 61.0+/-5.5% and the mean left atrial volume was 33.1+/-13.2 ml/m2. In patients without prior comorbidities, 8.2% had some echocardiographic abnormality (Figure 1). We found no significant differences in LVEF between symptomatic and asymptomatic patients (61.4% versus 60.6% respectively, p=0.104). Symptomatic patients showed slightly reduced GLS (-20.3% versus -20.9%, p=0.012) with a trend in the same direction in the RV free wall GLS (-25.6% versus -26.3%, p=0.103). Male patients were more likely to have any new echocardiographic abnormalities (OR 2.82, p=0.002). Time elapsed since infection resolution (p=0.245), the presence of symptoms (p=0.927), or history of hospitalization during infection (p=0.671) did not have any correlation with echocardiographic abnormalities. The difference between sexes remains unchanged after adjusting for left atrial volume, wall thicknesses, diastolic function and abnormal wall motion. Conclusion(s): Our results suggest that cardiovascular abnormalities after COVID-19 infection are rare and usually mild, especially in cases of mild disease. These abnormalities may be more frequent among males.
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BACKGROUND: Cardiovascular sequelae may occur in patients recovered from coronavirus disease 2019 (COVID-19). Recent studies have detected a considerable incidence of subclinical myocardial dysfunction-assessed with speckle-tracking echocardiography-and of long-COVID symptoms in these patients. This study aimed to define the long-term prognostic role of subclinical myocardial dysfunction and long-COVID condition in patients recovered from COVID-19 pneumonia. METHODS: We prospectively followed up 110 patients hospitalized at our institution due to COVID-19 pneumonia in April 2020 and then recovered from SARS-CoV-2 infection. A 7-month clinical and echocardiographic evaluation was performed, followed by a 21-month clinical follow-up. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction, stroke, heart failure hospitalization, and all-cause mortality. RESULTS: A subclinical myocardial dysfunction-defined as an impairment of left ventricular global longitudinal strain (≥-18%)-was identified at a 7-month follow-up in 37 patients (34%), was associated with an increased risk of long-term MACE with a good discriminative power (area under the curve: .73) and resulted in a strong independent predictor of extended MACE in multivariate regression analyses. Long-COVID condition was not associated with a worse long-term prognosis, instead. CONCLUSIONS: In patients recovered from COVID-19 pneumonia, a subclinical myocardial dysfunction is present in one-third of the whole population at 7-month follow-up and is associated with a higher risk of MACE at long-term follow-up. Speckle-tracking echocardiography is a promising tool to optimize the risk-stratification in patients recovered from COVID-19 pneumonia, while the definition of a long-COVID condition has no prognostic relevance.
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COVID-19 , Ventricular Dysfunction, Left , Humans , Risk Factors , Post-Acute COVID-19 Syndrome , COVID-19/complications , Predictive Value of Tests , SARS-CoV-2 , Prognosis , Ventricular Dysfunction, Left/complicationsABSTRACT
Objectives: At present, clinicians face plenty of patients complaining of post-COVID-19 chest pain and dyspnea. However, it remains to be seen if these symptoms indicate pathology of the cardiovascular system. We aimed to evaluate heart functions in outpatients with post-COVID-19 chest pain and dyspnea, using 2D speckle-tracking echocardiography (2D-STE). Method(s): This cross-sectional study recruited consecutive patients who presented to cardiology outpatient clinics between June 15, 2021, and July 15, 2021. A total of 78 patients had recovered from COVID-19 1-2 months before admission were included in the study. ECG and echocardiography, including 2D-STE images, were obtained for all patients. Findings were compared with sex- and an age-matched control group of 67 healthy adults. Result(s): The median age was 38 (IQR, 34-45) years, and 64.1% were female. There were no significant differences between the patients and control group regarding laboratory, ECG, and echocardiography findings. Moreover, the left ventricle global longitudinal strain measurements in both the patient and control groups were within the normal ranges and did not show a significant difference (-20.5 [-21.8- -17.9] vs. -19.8 [-21.4-18.9], p=0.894). Conclusion(s): Post-COVID-19 chest pain and dyspnea are unlikely signs of cardiovascular involvement in outpatient young adults who have not been hospitalized with COVID-19.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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Background/Introduction: Long coronavirus disease 2019 (COVID-19) was described in a significant number of discharged patients, with dyspnea being one of the most frequent complaint. Even though COVID-19 follow-up studies did not describe major left ventricle (LV) function abnormalities, subtle cardiac changes may be present. Purpose(s): We investigated the presence of subclinical cardiac dysfunction, assessed by transthoracic echocardiography (TTE) in recovered COVID-19 patients, without previous cardiopulmonary diseases at 1 year follow-up. Method(s): 310 consecutive COVID-19 patients were prospectively included.66 patients out of 251 recovered patients without history of cardiopulmonary diseases underwent 1 year follow-up consisting of clinical examination, chest computed tomography, spirometry and TTE Results: 23 (34.8%)patients out of 66 patients (mean age 51.3 +/- 11.1 years, 45 (68.2%)males) reported dyspnea at 1 year. TTE parameters were in the normal range, with a mean LV ejection fraction of 56.9 +/- 4.6%, mean global longitudinal strain (GLS) of -20.9 +/- 2.3%, global constructive work (GCW) of 2381.4 +/- 463.6mmHg% and global work index(GWI) of 2132.5 +/- 419.2mmHg%. A normal respiratory pattern was reported in 31(47%) patients at 6 months spirometry, while 19(28.8%) patients had restriction pattern. No significant differences regarding clinical, laboratory or imaging findings at baseline were found between groups. The following parameters were significantly different in patients with and without dyspnea at 1 year: GLS (-19.9 +/- 2.1 vs.- 21.3 +/- 2.3, p=0.039), GCW (2183.7 +/- 487.9 vs.2483.1 +/- 422.4, p=0.024) and GWI(1960.0 +/- 396.2 vs. 2221.1 +/- 407.9, p=0.030). Multivariable logistic regression showed that GCW and GWI were inversely and independently associated with persistent dyspnea at 1 year (p=0.035, OR 0.998, 95% CI 0.997-1.000;p=0.040, OR 0.998, 95% CI 0.997-1.000). Conclusion(s): Persistent dyspnea 1 year after COVID-19 was present in more than a third of patients without known cardiopulmonary diseases. GCW and GWI were the only echocardiographic parameters independently associated with symptoms, suggesting a decrease in myocardial performance in this population and subclinical cardiac dysfunction.
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Aim: To study the systolic function (SF) and diastolic function (DF) of the heart and to assess subclinical myocardial right ventricular (RV) dysfunction in pts after severe COVID-19. We examined 23 males aged 46-70 years (mean age - 58.8 +/- 12.6 yrs) discharged after COVID-19 (50-75% of the parenchymal damage) with exertional dyspnea. We performed transthoracic echocardiography (TTE) with assessment of RV global longitudinal strain (RV-GLS) and right ventricular free wall longitudinal strain (RVLS) using speckle tracking echocardiography. Result(s): The SF of the RV assessed by the excursion of the tricuspid valve ring (TAPSE) was preserved (2.1 +/- 0.6 cm) in all pts under study after severe COVID-19. The left ventricular (LV) ejection fraction was also preserved (62.1 +/- 4.7%) in all pts. TTE revealed normal ventricular and atrial dimensions: LV end-diastolic volume index (62.5 +/- 8.4 ml/m2) and RV end-diastolic diameter (2.7 +/- 0.6 cm), left atrial (LA) volume index (26.7 +/- 3.1 ml/m2) and right atrial (RA) volume index (20.2 +/- 4.5 ml/m2). LV DD was also detected: Grade I in 17 (74%) pts, and Grade II in 6 (16%) pts. Moderate pulmonary hypertension (PH) was present in all pts (time of acceleration of systolic flow in the pulmonary artery (AcT - 85.0 +/- 7.9 msec) as a consequence of significant pulmonary parenchymal involvement. We found reduced RV-GLS (-17.4 +/- 2.7%) and free wall RVLS (-18.9 +/- 3.1%) in 23 (100%) pts. Conclusion(s): Preserved LV and RV SF with Grade 1 and Grade 2 LV DD and moderate PH were established in pts after severe COVID-19. RV wall motion abnormalities with reduced RV-GLS and free wall RVLS were found, indicating the presence of subclinical RV myocardial dysfunction.
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Aim. To study the changes of morphological and functional right ventricular (RV) parameters depending on the severity of coronavirus infection 2019 (COVID-19) pneumonia over long-term follow-up. Material and methods. A total of 200 patients (men, 51,5%, mean age, 51,4+/-10,9 years) were examined at 2 control visits (3, 12 months after receiving two negative polymerase chain reaction tests). Patients were divided into following groups: group I (n=94) - lung tissue involvement >=50% according to inhospital chest computed tomography (chest CT), group II (n=106) - lung tissue involvement <50% according to chest CT. Results. The groups were comparable in key clinical and functional parameters 3 months after COVID-19 pneumonia. Speckle tracking echocardiography (STE) revealed a significant increase in following global longitudinal strain (LS) parameters: RV free wall endocardial LS (-22,7+/-3,2% and-24,3+/-3,8% in group I, p<0,001;-23,2+/-3,5% and-24,5+/-3,4% in group II, p<0,001), and RV endocardial LS (-21,0+/-3,1% and-22,5+/-3,7% in group I, p<0,001,-21,5+/-3,2% and-22,6+/-3,3% in group II, p=0,001). Significant increase of segmental endocardial LS was revealed in group I in the basal segments of RV free wall (-26,2+/-5,1% and-28,1+/-5,1%, p=0,004) and interventricular septum (IVS) (-16,2 [13,9;19,5]% and-17,5 [14,6;21,4]%, p=0,024), IVS middle segment (-20,3+/-4,1% and-21,5+/-4,8%, p=0,030), as well as in group II in the apical segments of RV free wall (-21,9+/-6,7% and-24,4+/-5,2%, p=0,001) and IVS (-23,7+/-4,7% and-24,9+/-4,8%, p=0,014). Conclusion. Recovery of RV function during a 12-month follow-up period in patients with both severe and moderate/mild lung involvement in COVID-19 was detected using the STE method.Copyright © 2023, Silicea-Poligraf. All rights reserved.
ABSTRACT
Aim. To study the changes of morphological and functional right ventricular (RV) parameters depending on the severity of coronavirus infection 2019 (COVID-19) pneumonia over long-term follow-up. Material and methods. A total of 200 patients (men, 51,5%, mean age, 51,4+/-10,9 years) were examined at 2 control visits (3, 12 months after receiving two negative polymerase chain reaction tests). Patients were divided into following groups: group I (n=94) - lung tissue involvement >=50% according to inhospital chest computed tomography (chest CT), group II (n=106) - lung tissue involvement <50% according to chest CT. Results. The groups were comparable in key clinical and functional parameters 3 months after COVID-19 pneumonia. Speckle tracking echocardiography (STE) revealed a significant increase in following global longitudinal strain (LS) parameters: RV free wall endocardial LS (-22,7+/-3,2% and-24,3+/-3,8% in group I, p<0,001;-23,2+/-3,5% and-24,5+/-3,4% in group II, p<0,001), and RV endocardial LS (-21,0+/-3,1% and-22,5+/-3,7% in group I, p<0,001,-21,5+/-3,2% and-22,6+/-3,3% in group II, p=0,001). Significant increase of segmental endocardial LS was revealed in group I in the basal segments of RV free wall (-26,2+/-5,1% and-28,1+/-5,1%, p=0,004) and interventricular septum (IVS) (-16,2 [13,9;19,5]% and-17,5 [14,6;21,4]%, p=0,024), IVS middle segment (-20,3+/-4,1% and-21,5+/-4,8%, p=0,030), as well as in group II in the apical segments of RV free wall (-21,9+/-6,7% and-24,4+/-5,2%, p=0,001) and IVS (-23,7+/-4,7% and-24,9+/-4,8%, p=0,014). Conclusion. Recovery of RV function during a 12-month follow-up period in patients with both severe and moderate/mild lung involvement in COVID-19 was detected using the STE method.Copyright © 2023, Silicea-Poligraf. All rights reserved.
ABSTRACT
Aim. To study the changes of morphological and functional right ventricular (RV) parameters depending on the severity of coronavirus infection 2019 (COVID-19) pneumonia over long-term follow-up. Material and methods. A total of 200 patients (men, 51,5%, mean age, 51,4+/-10,9 years) were examined at 2 control visits (3, 12 months after receiving two negative polymerase chain reaction tests). Patients were divided into following groups: group I (n=94) - lung tissue involvement >=50% according to inhospital chest computed tomography (chest CT), group II (n=106) - lung tissue involvement <50% according to chest CT. Results. The groups were comparable in key clinical and functional parameters 3 months after COVID-19 pneumonia. Speckle tracking echocardiography (STE) revealed a significant increase in following global longitudinal strain (LS) parameters: RV free wall endocardial LS (-22,7+/-3,2% and-24,3+/-3,8% in group I, p<0,001;-23,2+/-3,5% and-24,5+/-3,4% in group II, p<0,001), and RV endocardial LS (-21,0+/-3,1% and-22,5+/-3,7% in group I, p<0,001,-21,5+/-3,2% and-22,6+/-3,3% in group II, p=0,001). Significant increase of segmental endocardial LS was revealed in group I in the basal segments of RV free wall (-26,2+/-5,1% and-28,1+/-5,1%, p=0,004) and interventricular septum (IVS) (-16,2 [13,9;19,5]% and-17,5 [14,6;21,4]%, p=0,024), IVS middle segment (-20,3+/-4,1% and-21,5+/-4,8%, p=0,030), as well as in group II in the apical segments of RV free wall (-21,9+/-6,7% and-24,4+/-5,2%, p=0,001) and IVS (-23,7+/-4,7% and-24,9+/-4,8%, p=0,014). Conclusion. Recovery of RV function during a 12-month follow-up period in patients with both severe and moderate/mild lung involvement in COVID-19 was detected using the STE method.Copyright © 2023, Silicea-Poligraf. All rights reserved.
ABSTRACT
Cardiovascular complications are frequently reported in COVID-19 patients and are associated with increased mortality during hospitalization. However, no data exists on cardiac involvement in patients recovered from COVID-19 infection. Our study suggests a need for closer follow-up among COVID-19 recovered subjects including echocardiographic assessment of left ventricular function to elucidate long-term cardiovascular outcomes by early detection of left ventricular dysfunction.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Background: Left ventricular global longitudinal strain (LV-GLS) has been recently demonstrated to be predictive of poor outcomes in various cardiovascular settings. Therefore, this study sought to investigate the prognostic implications of LV-GLS in patients with coronavirus disease 2019 (COVID-19). Method(s): This prospective study enrolled 180 consecutive hospitalized patients with COVID-19 admitted to a tertiary care hospital. LV-GLS from the apical four-chamber view was obtained using two-dimensional speckle-tracking echocardiography (2D-STE). Patients with diabetes, hypertension, heart failure, atrial fibrillation, and/or ischemic heart disease were excluded from the study. A correlation between LV-GLS and interleukin-6 (IL-6) levels, C-reactive protein (CRP) levels, in-hospital mortality, intensive care unit (ICU), and hospital stay were sought. Result(s): The mean age of included patients was 58 +/- 16 years. The mean left ventricular ejection fraction (LVEF) was 70.2 +/-6.5, the mean GLS was -21.9+/-4.3. Mean IL-6 and CRP were 9.9 +/- 7.8 pg/ml and 25.8 +/- 25.8 mg/dl respectively. Mean ICU and hospital stay were 7.5 +/- 3.14 and 10.7 +/- 4.03 days respectively. The in-hospital mortality rate was 2.22% (4 patients). Pearson correlation showed a negative correlation between LV-GLS and IL-6, CRP, ICU, and hospital stay (correlation coefficient r= -0.273, -0.301, -0.275, and -0.259 respectively). Conclusion(s): In an observational cohort study, LV-GLS had a negative correlation with laboratory and clinical outcomes in hospitalized COVID-19 patients. So far, long-term cardiovascular complications of COVID-19 are still unknown. Several reports indicate that GLS can be used as a validated method for early prediction of poor outcomes in COVID-19 patients even after the resolution of the original infection. [Formula presented]Copyright © 2023