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Background: The 2019 novel coronavirus disease (COVID-19) has been reported as pandemy and the number of patients continues to rise. Based on recent data, cardiac injury is a prominent feature of the disease, leading to increased morbidity and mortality. In the present study we aimed to evaluate myocardial dysfunction using transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) in hospitalized COVID-19 patients. Methods and Results: We recruited 30 patients (56.7% male, 55.80 +/- 14.949 years) who were hospitalized with the diagnosis COVID-19 infection. We analyzed left ventricular (LV) and right ventricular (RV) conventional and TDI parameters at the time of hospitalization and during the course of the disease. Patients without any cardiac disease and with preserved LV ejection fraction (EF) were included. TTE examination was performed and all the variables were recorded and analyzed retrospectively. We observed that both LV and RV conventional echocardiographic parameters were similar when the day of admission to the hospital was compared to the 5th day of the disease. Regarding TDI analysis, we demonstrated significant impairment in LV septal and lateral deformation (P < 0.001). In the correlation analysis no marked correlation was observed between impairment in LV deformation and inflammation biomarkers. Conclusion(s): Cardiac involvement is an important feature of the COVID-19 infection but the exact mechanism is still undefined. Echocardiography is an essential technique to describe myocardial injury and provide new concepts for the possible definitions of cardiac dysfunction.Copyright © 2023 The Author(s).
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Introduction: After the outbreak of the Corona Virus Disease 2019 (COVID-19), there have been reports of impaired cardiac function in patients infected with this coronavirus. The tests are mostly based on myocardial injury markers and routine cardiac ultrasound examinations, which are mostly seen in critically ill patients. In this study, two-dimensional speckle tracking imaging (2DSTI) combined with Tei index and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were used to more sensitively diagnose cardiac function impairment in COVID-19 patients. Materials and methods: For some COVID-19 patients in our hospital, there were 68 cases of mild disease (including mild and common types) and 11 cases of severe disease (4 cases of severe death), and 10 healthy volunteers were included as the control group. On the basis of conventional echocardiography in all subjects, the left ventricular end-diastolic volume (LV-EDV), left ventricular end-systolic volume (LV-ESV), and left ventricular ejection fraction (LV-EF) were obtained by Simpson method, the left ventricular Tei index by tissue Doppler, and the left ventricular global peak longitudinal strain (GLPS), left ventricular global peak radial strain (GRPS), and left ventricular global peak circumferential strain (GCPS) by 2DSTI offline analysis. The COVID-19 patients were subjected to quantitative detection of serum NT-proBNP for statistical analysis. Results: Left ventricular GLPS, left ventricular GRPS, and left ventricular GCPS in COVID-19 patients were significantly lower than those in the control group (P<0.05): The left ventricular GLPS was more significant (P<0.01), and the severe group (including the death group) < the mild group < the control group. The left ventricular Tei index: The severe group (including the death group) of COVID-19 was significantly higher than the mild group and the control group (P<0.05), and there was no statistical significance between the mild group and the control group. NT-proBNP: The severe group of COVID-19 was significantly higher than the mild group (P<0.05). Although the LV-EF in the COVID-19 patients was significantly lower than that in the control group (P<0.05), except for 2 sever cases less than 50%, the rest were all ≥50%;although there was a significant difference in LV-ESV among multiple groups (P<0.05), but there was no significant difference for the pairwise comparison, and there was no significant difference in LV-EDV. Conclusion: 2DSTI can more sensitively detect latent cardiac function impairment in COVID-19 patients, and the left ventricular GLPS is the most sensitive. Tei index is an effective indicator to reflect the degree of cardiac function impairment. NT-proBNP has significant significance in predicting the severity of cardiac dysfunction. The combined application of the three can significantly increase the predictive performance of cardiac function impairment, provide a diagnostic basis for cardiac function impairment with preserved ejection fraction, and predict the degree of impairment. Our study demonstrated that the cardiac function of COVID-19 patients is impaired to varying degrees.
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Introduction: Paediatric Inflammatory Multisystem Syndrome Temporarily associated with SARS-CoV-2 (PIMS-TS) is commonly associated with cardiovascular compromise. We have previously described the time course and magnitude of left ventricular (LV) systolic dysfunction in children and young adults with PIMSTS. However, it remains unknown if this inflammatory process can cause LV dyssynchrony. We aim to establish whether paediatric patients with PIMS TS develop LV dyssynchrony as assessed by echocardiography. Methods: Comprehensive transthoracic echocardiography in 10 PIMS-TS patients was performed during the acute stage of the initial illness when LV systolic function (3D Ejection Fraction (EF)) was worst and then again at six months post PIMS-TS. At both time points, we compared: 3D EF, LV fractional shortening (FS) and global longitudinal strain (GLS). Intraventricular LV dyssynchrony was assessed byMmode, PW tissue Doppler Velocities (TDI), 2-D speckle tracking and 3D echocardiography, while the interventricular dyssynchrony was also assessed by TDI at both time points. Results: Any improvement in 3D-LV EF at six months post illness (57.8±5.5 %) vs acute phase (51.8± 9.9%) was not statistically significant (p=0.166), whereas the LV FS (29.9± 9.5% vs 36.5± 12.5%, p=0.043) and GLS (-13.8±1.9% vs -18.6±3.1%, p=0.005) were significantly lower during the acute phase of the illness compared to six months later. Regarding dyssynchrony, none of the measures differed at follow up compared with acute phase;the septal to posterior wall motion delay assessed by Mmode (46.1±2.7msec vs 38.6±2.1msec, p=0.417), the basal septal to basal lateral peak velocity delay assessed by TDI (23.2±1.9.msec vs 24±1.9msec, p=0.930), the 2D speckle tracking-derived strain delay index was 1.1±1.2% at the time of the worst LV systolic performance and 0.62±0.26% at 6 months in the recovery period (p=0.219). The 3D echocardiography demonstrated that the 3D systolic dyssynchrony index (SDI) remained similar throughout the follow up period (3.04±1.23% at baseline vs 3.22±1.25% at 6 months, p=0.466). Conclusions: Despite the fact that in patients with PIMS TS cardiac involvement show a decline on LV systolic performance, this does not appear to be associated with LV dyssynchrony as assessed by echocardiography. We recommend larger patient cohort studies to investigate this further.
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Relevance: Current and past coronavirus infection can provoke and aggravate the course of previous chronic heart failure by initiating the processes of thrombus formation, inflammation and fibrinogen synthesis, affecting the pleuropericardial space, increasing the load on the right heart due to pulmonary hypertension. Purpose of the study: To identify the features of chronic heart failure after COVID-19 infection with lung damage. Material: An open cohort prospective study of 50 patients was carried out. Inclusion criteria: the presence of a positive brain natriuretic peptide and echocardiographic changes corresponding to systolic or diastolic dysfunction before the onset of the pandemic, signed informed consent. The diagnosis of COVID - 19 was confirmed by a positive PCR test and the presence of M and G antibodies, lung damage - by the results of computed tomography of the lungs. Methods: Standard clinical examination, quality of life questionnaire, echocardiography with measurement of cavity volume, indicators of left ventricular systolic and diastolic function, size and function of the right ventricle. The second examination was carried out one month after hospitalization. Results: The features of the clinical picture were an increase in shortness of breath (38 people, 86%), a decrease in exercise tolerance (40 people, 90%), an increase in chest pain (25 people, 60%), palpitations (40 people, 90%). On echocardiography, the most frequent dynamics compared to the 2019 echocardiography indicators were an increase in pressure in the pulmonary artery (44 people, 100%), the size of the right (38 people, 86%) and left ventricles (30 people, 68%), left atrium (38 people, 86%), an increase in the severity of valvular regurgitation (44 people, 100%) and a decrease in the ejection fraction within the gray zone (38 people, 86%). The newly emerging decrease in EF below 45% was recorded much less frequently, in 13 people (30%). In 40 (80%) patients, certain signs of deterioration of left ventricular diastolic function were revealed: dilatation of the left atrium, decrease in the mean e, increase in E/e' according to tissue Doppler ultrasonography. The TAPSE index, which characterizes the global function of the right ventricle, practically did not decrease. Frequent findings during echocardiography one month after the disease were a small amount of fluid in the pericardial cavity (30 people, 68%) and pleuropericardial adhesions. Conclusion: The clinical condition of patients with CHF in the first month after a previous infection with COVID-19 with lung involvement corresponded to a worsening of CHF with rhythm disturbances and instability of blood pressure, which on echocardiographic examination was manifested by dilatation of the heart cavities, valvular regurgitation, diastolic dysfunction of the left ventricle and increased pressure in the arteries.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein binds to angiotensin-converting enzyme 2 (ACE2) receptor on vascular cells. As a consequence, patients with COVID-19 have an increased incidence of thromboembolic complications of the SARS-CoV-2 infection and subsequent endothelial cell damage with consequence of development of systemic vasculitis and diffuse intravascular coagulation. The present case describes a COVID-19 female patient with ischemic dilated cardiomyopathy, who presented with congestive heart failure and echocardiographic evidence of biventricular apical thrombi. The peak antegrade longitudinal velocity (Va) of each thrombotic mass was measured by pulsed wave tissue Doppler imaging (PW-TDI). Both left ventricular and right ventricular apical thrombi were found with a TDI-derived mass peak Va < 10 cm/s. There was no clinical evidence of neither systemic nor pulmonary embolization, probably due to the hypomobility of both left and right ventricular masses.
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BACKGROUND: COVID-19 has caused considerable morbidity and mortality worldwide and cardiac involvement has been reported during infection. The short-term cardiac outcome in survivors of COVID-19 is not known. OBJECTIVE: To examine the heart of patients who survived COVID-19 and to compare the cardiac outcome between patients who recovered from mild-to-moderate or severe illness. METHODS: With use of ECG and echocardiography, we examined the heart of 105 patients who had been hospitalized with COVID-19 and were consecutively recruited after hospital discharge while attending follow-up visits. Survivors of COVID-19 were compared with 105 matched controls. We also compared the cardiac outcome and lung ultrasound scan between COVID-19 patients who had mild-to-moderate or severe illness. RESULTS: Cardiac data were collected a median of 41 days from the first detection of COVID-19. Symptoms were present in a low percentage of patients. In comparison with matched controls, no considerable structural or functional differences were observed in the heart of survivors of COVID-19. Lung ultrasound scan detected significantly greater residual pulmonary involvement in COVID-19 patients who had recovered from severe than mild-to-moderate illness. No significant differences were detected in ECG tracings nor were found in the left and right ventricular function of patients who had recovered from mild-to-moderate or severe illness. CONCLUSIONS: In a short-term follow-up, no abnormalities were identified in the heart of survivors of COVID-19, nor cardiac differences were detected between patients who had different severity of illness. With the limitations of a cross-sectional study, these findings suggest that patients who recover from COVID-19 do not have considerable cardiac sequelae.