Left Ventricular Global Longitudinal Strain as a Parameter of Mild Myocardial Dysfunction in Athletes after COVID-19.

Whether symptoms during COVID-19 contribute to impaired left ventricular (LV) function remains unclear. We determine LV global longitudinal strain (GLS) between athletes with a positive COVID-19 test (PCAt) and healthy control athletes (CON) and relate it to symptoms during COVID-19. GLS is determined in four-, two-, and three-chamber views and assessed offline by a blinded investigator in 88 PCAt (35% women) (training at least three times per week/>20 MET) and 52 CONs from the national or state squad (38% women) at a median of two months after COVID-19. The results show that the GLS is significantly lower (GLS -18.53 ± 1.94% vs. -19.94 ± 1.42%, p < 0.001) and diastolic function significantly reduces (E/A 1.54 ± 0.52 vs. 1.66 ± 0.43, p = 0.020; E/E'l 5.74 ± 1.74 vs. 5.22 ± 1.36, p = 0.024) in PCAt. There is no association between GLS and symptoms like resting or exertional dyspnea, palpitations, chest pain or increased resting heart rate. However, there is a trend toward a lower GLS in PCAt with subjectively perceived performance limitation (p =0.054). A significantly lower GLS and diastolic function in PCAt compared with healthy peers may indicate mild myocardial dysfunction after COVID-19. However, the changes are within the normal range, so that clinical relevance is questionable. Further studies on the effect of lower GLS on performance parameters are necessary.

Right atrial reservoir strain and right ventricular strain improves in patients recovered from hospitalisation for non-severe COVID-19.

PURPOSE: Those hospitalised with coronavirus disease 2019 (COVID-19) have recently been shown to have impaired right ventricular (RV) strain, but data about the course of heart function after discharge are limited. Our aim was to compare right ventricular strain and right atrial reservoir strain (RASr) associated with COVID-19 between acute disease (during hospitalisation) and follow-up (after discharge). METHODS: In this retrospective single-center study, we analysed the echocardiograms of 43 patients hospitalised for non-severe COVID-19 between December 2020 and March 2021, undergoing echocardiography both during and after hospitalisation. In addition to conventional echocardiographic parameters, we applied 2-dimensional speckle tracking to obtain RV global longitudinal strain (RV-GLS), RV free wall strain (RV-FWS), and RASr. RESULTS: Mean (standard deviation) age of the study population was 50 (9) years, and 18 (42%) of the participants were women. Median duration between exams was 6 months (range, 5-7 months). Both mean RV-GLS and mean RV-FWS significantly increased at follow-up (-20.8 [3.8] vs. -23.5 [2.8], p < 0.001 and -23.3 [4.2] vs. -28.2 [2.8], p < 0.001; respectively), and RASr significantly improved as well (-32.3 [6.6] vs. -41.9 [9.8], p < 0.001). CONCLUSION: In patients hospitalised for non-severe COVID-19 pneumonia, RV-GLS, RV-FWS, and RASr improved significantly between acute disease and 6 months after discharge.

Relationship between latent left ventricular contractile dysfunction and signs of immune inflammation in patients with COVID-19 pneumonia.

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.

Echocardiographic Changes At Follow-up In Patients With Myocardial Dysfunction During Acute Coronavirus Disease 2019 (COVID-19) Infection

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

Strain Echocardiography in Acute COVID-19 and Post-COVID Syndrome: More than Just a Snapshot.

Speckle-tracking echocardiography (STE) has become an established, widely available diagnostic method in the past few years, making its value clear in cases of COVID-19 and the further course of the disease, including post-COVID syndrome. Since the beginning of the pandemic, many studies have been published on the use of STE in this condition, enabling, on the one hand, a better understanding of myocardial involvement in COVID-19 and, on the other, a better identification of risk to patients, although some questions remain unanswered in regard to specific pathomechanisms, especially in post-COVID patients. This review takes a closer look at current findings and potential future developments by summarising the extant data on the use of STE, with a focus on left and right ventricular longitudinal strain.

Evaluation of Chest Pain and Dyspnea Symptoms Using Speckle-Tracking Echocardiography in Patients Recovering from COVID-19

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.

Right ventricular myocardial dysfunction in patients (pts) after severe coronavirus disease (COVID-19)

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.

Dynamics of global and segmental strain as a marker of right ventricular contractility recovery in patients after COVID-19 pneumonia.

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.

Dynamics of global and segmental strain as a marker of right ventricular contractility recovery in patients after COVID-19 pneumonia.

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.

Dynamics of global and segmental strain as a marker of right ventricular contractility recovery in patients after COVID-19 pneumonia.

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.

Prognostic Value Of Echocardiographic Evaluation Of Left Ventricular Function In Recovered Covid-19 Patients

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.

CRT-200.05 Correlation Between Left Ventricular Longitudinal Strain and Laboratory Parameters and Clinical Outcomes in Hospitalized COVID-19 Patients

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

Strain in children with MIS-C and acute COVID-19.

Context: Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. Aims: We sought to describe strain findings in both the groups on initial presentation and follow-up. Settings and Design: A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. Subjects and Methods: TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. Results: Forty-five patients (34 - MIS-C and 11 - COVID-19) met the inclusion criteria. There was a statistically significant decrease in LV longitudinal strain (P < 0.001), LV circumferential strain (P < 0.001), and left atrial strain (P = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain (P = 0.028) in the acute COVID-19 group. All patients with abnormal left ventricular EF (LVEF) had abnormal strain. However, 14 (41%) patients in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. There was a significant correlation with LV longitudinal strain (P = 0.005) and LVEF (P = 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. Conclusions: Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.

Advanced Echocardiographic Analysis in Medium-Term Follow-Up of Children with Previous Multisystem Inflammatory Syndrome.

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were enrolled and underwent advanced echocardiogram at discharge and at 6 months. According to the left ventricular ejection fraction (LVEF) at admission, the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥ 45%) and the follow-up results were compared. At discharge, all patients had normal LV and RV systolic function (LVEF 61 ± 4.4%, LV global longitudinal strain -22.1%, TAPSE 20.1mm, s' wave 0.13m/s, RV free wall longitudinal strain -27.8%) with normal LV diastolic function (E/A 1.5, E/e' 5.7, and left atrial strain 46.5%) and no significant differences at 6 months. Compared to group B, the group A patients showed a reduced, even if normal, LV global longitudinal strain at discharge (-21.1% vs. -22.6%, p-value 0.02), but the difference was no longer significant at the follow-up. Patients with MIS-C can present with depressed cardiac function, but if treated, the cardiac function recovered without late onset of cardiac disease. This favorable result was independent of the severity of acute LV dysfunction.

Characteristic Immune Dynamics in COVID-19 Patients with Cardiac Dysfunction.

BACKGROUND: We aimed to explore immune parameters in COVID-19 patients admitted to the intensive care unit (ICU) to identify distinctive features in patients with cardiac injury. METHODS: A total of 30 COVID-19 patients >18 years admitted to the ICU were studied on days D1, D3 and D7 after admission. Cardiac function was assessed using speckle-tracking echocardiography (STE). Peripheral blood immunophenotyping, cardiac (pro-BNP; troponin) and inflammatory biomarkers were simultaneously evaluated. RESULTS: Cardiac dysfunction (DYS) was detected by STE in 73% of patients: 40% left ventricle (LV) systolic dysfunction, 60% LV diastolic dysfunction, 37% right ventricle systolic dysfunction. High-sensitivity cardiac troponin (hs-cTn) was detectable in 43.3% of the patients with a median value of 13.00 ng/L. There were no significant differences between DYS and nDYS patients regarding mortality, organ dysfunction, cardiac (including hs-cTn) or inflammatory biomarkers. Patients with DYS showed persistently lower lymphocyte counts (median 896 [661-1837] cells/µL vs. 2141 [924-3306] cells/µL, p = 0.058), activated CD3 (median 85 [66-170] cells/µL vs. 186 [142-259] cells/µL, p = 0.047) and CD4 T cells (median 33 [28-40] cells/µL vs. 63 [48-79] cells/µL, p = 0.005), and higher effector memory T cells (TEM) at baseline (CD4%: 10.9 [6.4-19.2] vs. 5.9 [4.2-12.8], p = 0.025; CD8%: 15.7 [7.9-22.8] vs. 8.1 [7.7-13.7], p = 0.035; CD8 counts: 40 cells/µL [17-61] vs. 10 cells/µL [7-17], p = 0.011) than patients without cardiac dysfunction. CONCLUSION: Our study suggests an association between the immunological trait and cardiac dysfunction in severe COVID-19 patients.

Comparison of biventricular myocardial strain according to treatment regimens in patients discharged after COVID-19 recovery

Purpose: The effects of different COVID-19 therapeutic strategies on cardiac function are uncertain. Therefore, this study aimed to evaluate the effects of different medical treatments on biventricular function in patients who had recovered from COVID-19. Materials and Methods: Speckle-tracking echocardiography was performed to examine the biventricular myocardial function of patients at follow-up visits after recovery from COVID-19. The patients were divided into two groups based on the medication they used during the active disease: favipiravir (FAV;n = 60) or hydroxychloroquine (HCQ;n = 60). A comparison was made with risk factor-matched controls (n = 41). Results: A total of 161 patients were included in the study. The left ventricular end-diastolic volume, end-systolic volume, end-diastolic diameter, and end-systolic diameter were higher in the HCQ and FAV groups compared to the controls, while the left ventricular ejection fraction was similar between all the groups. The right ventricular diameter was increased, and the systolic pulmonary artery pressure was higher in the HCQ and FAV groups compared to the controls. The left ventricular global longitudinal strain (-18 +/- 6.6 vs. -19.7 +/- 4.4 vs. -20.4 +/- 5, respectively), the right ventricular global longitudinal strain (-19.8 +/- 7.5 vs. -22.2 +/- 6 vs. -23.4 +/- 6.2, respectively), and the right ventricular free wall strain (-16.9 +/- 3.6 vs. -18.2 +/- 2.4 vs. -19.6 +/- 4.7, respectively) were worse in the HCQ group compared to the FAV and control groups. Conclusion: This study found echocardiographic evidence of subclinical cardiac involvement in both the HCQ and FAV groups compared to the controls. However, HCQ treatment was associated with an increased risk of biventricular subclinical systolic dysfunction in COVID-19 survivors compared with FAV treatment.

Clinical profile and the extent of residual myocardial dysfunction among patients with previous coronavirus disease 2019.

BACKGROUND: Many patients who have recovered from their coronavirus disease 2019 (COVID-19) episode continue to remain symptomatic and seek medical opinion. The clinical characteristics and echocardiography findings of such subjects have not been adequately studied. METHODS: The study included 472 subjects (age 54.0 ± 13.4 years, 57% men) with previous COVID-19 (median duration since COVID-19 12.0 weeks, interquartile range 9.0-26.0 weeks) and 100 controls (age 53.9 ± 13.6 years, 53% men). All subjects underwent detailed clinical assessment and echocardiography, including measurement of left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS). RESULTS: Less than third (29.2%) of the post-COVID subjects had needed hospitalization for their initial infection. Exertional dyspnea or breathing difficulty at rest were the commonest reasons for post-COVID presentation. As compared to controls, the post-COVID subjects had impaired LV systolic (LVEF 63.2 ± 2.2 vs. 61.9 ± 4.6, P = 0.007; GLS - 19.9 ± 2.6% vs. -17.6 ± 3.4%, P < 0.001) and diastolic function. Majority of those with reduced LV GLS had preserved LVEF. The patients presenting before 12 weeks were more likely to be symptomatic, but LV GLS did not differ. The patients needing hospitalization had higher burden of co-morbidities and significantly reduced LV GLS as compared to those who had received domiciliary treatment. The patients in the lowest GLS tertile were older, had higher burden of co-morbidities, and had had more severe initial infection with greater need for hospitalization, oxygen therapy and steroids. The need for hospitalization was independently associated with lower GLS at the time of current presentation. CONCLUSION: This study shows that impairment of LV systolic and diastolic function is common among subjects recovering from previous COVID-19 episode. The patients with more severe initial infection have more marked impairment of LV function and this impairment persists even after several months of recovery from the initial infection. Routine measurement of GLS may be helpful since LV systolic dysfunction in these patients is mostly subclinical.

Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19.

BACKGROUND: Right ventricular (RV) dysfunction has been commonly reported in patients with Coronavirus disease 2019 (COVID-19), and is associated with mortality in mixed cohorts of patients requiring and not requiring invasive mechanical ventilation (IMV). Using RV-speckle tracking echocardiography (STE) strain analysis, we aimed to identify the prevalence of RV dysfunction (diagnosed by abnormal RV-STE) in patients with COVID-19 that are exclusively undergoing IMV, and assess association between RV dysfunction and 30 day mortality. We performed a prospective multicentre study across 10 ICUs in Scotland from 2/9/20 to 22/3/21. One-hundred-and-four echocardiography scans were obtained from adult patients at a single timepoint between 48 h after intubation, and day 14 of intensive care unit admission. We analysed RV-STE using RV free-wall longitudinal strain (RVFWLS), with an abnormal cutoff of > -20%. We performed survival analysis using Kaplan-Meier, log rank, and multivariate cox-regression (prespecified covariates were age, gender, ethnicity, severity of illness, and time since intubation). RESULTS: Ninety-four/one-hundred-and-four (90.4%) scans had images adequate for RVFWLS. Mean RVFWLS was -23.0% (5.2), 27/94 (28.7%) of patients had abnormal RVFWLS. Univariate analysis with Kaplan-Meier plot and log-rank demonstrated that patients with abnormal RVFWLS have a significant association with 30-day mortality (p = 0.047). Multivariate cox-regression demonstrated that abnormal RVFWLS is independently associated with 30-day mortality (Hazard-Ratio 2.22 [1.14-4.39], p = 0.020). CONCLUSIONS: Abnormal RVFWLS (> -20%) is independently associated with 30-day mortality in patients with COVID-19 undergoing IMV. Strategies to prevent RV dysfunction, and treatment when identified by RVFWLS, may be of therapeutic benefit to these patients. TRIAL REGISTRATION: Retrospectively registered 21st Feb 2021. CLINICALTRIALS: gov Identifier: NCT04764032.

2D speckle-tracking echocardiography as a prognostic imaging modality for COVID-19 adverse outcomes.

Aim: 2D speckle-tracking echocardiography (2D-STE) has been used to assess cardiac recovery during the COVID-19 patient follow-ups within the pandemic. The novel role of STE in predicting adverse outcomes of COVID-19 has received attention due to its high sensitivity in identifying subclinical myocardial dysfunction. We reviewed the studies on using 2D-STE to assess COVID-19 prognosis. Methods: a literature search was conducted on PubMed and Scopus for eligible articles, 24 of which discussed using prognostic 2D-STE for COVID-19 patients. Results: 2D-STE predicts cardiovascular impairments more rapidly and precisely than conventional echocardiography. The 2D-STE technique presents an independent prognostic factor in COVID-19 infection. Conclusion: 2D-STE could be considered a time-efficient and accurate risk predictor of all-cause mortality in COVID-19 patients.

In this review, we have gathered every article that discusses the association between COVID-19 prognosis and speckle-tracking echocardiography, which is a novel, fast and accurate method and does not need expert operators to perform. We have shown that according to the current literature, we can use this imaging technique on the right and left heart ventricles to estimate the prognosis of the patients infected with COVID-19.

Role of cardiovascular magnetic resonance imaging in COVID-19 recovered patients: A short-term follow-up study.

OBJECTIVE: Cardiac involvement in recovered COVID-19 patients assessed by cardiac magnetic resonance imaging (MRI). METHODS: Subjects recently recovered from COVID-19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30-90 days following recovery from COVID-19) with a follow-up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). RESULTS: All the 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID-19-recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID-19 [3/4;75%]). Subjects with severe COVID-19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p < .0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p = .04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. CONCLUSIONS: An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one-fourth at 6 months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long-term cardiovascular sequelae. COVID-19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution.