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.

Speckle Tracking Echocardiography in Post Covid 19 Recovered Patients

Background:Speckle tracking echocardiography represents an advanced, noninvasive imaging modality that allows a fast and accurate assessment of the global and regional function of both atrial and ventricular chambers, independently from the angle of insonation and in-plane translational motion. STE is based on the interaction between the myocardial tissue and the ultrasound beam that produces particular acoustic markers. Objective:To assess left atrial strain and strain rate in patients recovered from COVID-19.Conclusion:COVID-19 may unmask subclinical Left Atrial (LA) dysfunction or exacerbate preexisting LA dysfunction. Moreover, recent findings suggested that COVID-19 patients with severe respiratory failure had a high prevalence of increased LVEDP. However, data about the potential effect of COVID-19 on LAcd function are currently lacking.

Evolution of echocardiographic and cardiac MRI abnormalities during follow-up in patients with previous MIS-C diagnosis

Background and Aim: Growing evidence has documented a severe systemic hyperinflammation syndrome affecting children previ-ously exposed to SARS-CoV-2, known as Multisystem Inflammatory Syndrome in Children (MIS-C). Cardiovascular manifestations in MIS-C are frequent (34%-82%). The aim of our study was to describe the early and late cardiac abnormalities in patients with MIS-C, assessed by standard echocardiography, speckle tracking echocardiography (STE), and cardiac MRI (CMR). Method(s): 32 consecutive patients (21M, 11F), mean age 8.25 +/- 4years (range 1.3-17.7), with confirmed MIS-C diagnosis were enrolled in this study. Clinical, laboratory and microbiological data were collected. At disease onset, all children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS) and 23 (75%) of them performed CMR. Patients underwent complete cardiological evaluation, including echocardiography and STE at two months (T1) and six months (T2) after diagnosis. CMR was repeated at six months after diagnosis. Result(s): Cardiovascular symptoms were present in 45.8% of cases. Thirteen children (40.6%) shared Kawasaki Disease-like symp-toms, and 5 (15.6%) needed ICU admission. Early survival was 100%. All patients showed an hyperinflammatory state. Tn-I was elevated in 20 (62.5%) and BNP in 28 (87.5%) patients. Mean LVEF at baseline was 58.8 +/- 10% with 10 patients (31%) below 55%. STE showed reduced mean LV GLS (-17.4 +/- 4%). On CMR, LGE with nonischemic pattern was evident in 8/23 patients (35%). Follow-up data showed rapid improvement of LVEF at T1 (62.5 +/- 7.5 vs. 58.8 +/- 10.6%, p value 0.044) with only three patients (10%) below <= 55% at T1 and one (4%) at T2. LV GLS remained impaired at T1 (-17.2 +/- 2.7 vs.-17.4 +/- 4, p value 0.71), and significantly improved at T2 (-19 +/- 2.6% vs.-17.4 +/- 4%, p value 0.009). LV GLS was impaired (gt;-18%) in 53% of patients at baseline and T1, while only 13% showed persistent LV GLS reduc-tion at T2. Follow-up CMR showed LGE persistence in 33.4% of cases. Conclusion(s): Even though, early cardiac involvement significantly improves during follow-up, subclinical myocardial damage seems to be still detectable 6 months follow up in one third of MIS-C patients.

4 Dimensional XStrain speckle tracking echocardiography: comprehensive evaluation of left ventricular strain and twist parameters in healthy Indian adults during COVID-19 pandemic.

INTRODUCTION: 4D XStrain speckle tracking echocardiography (STE) is a feasible newer technology to evaluate the strain and rotational deformation of left ventricle (LV). We aimed to exhaustively present the normal value ranges of LV strain and twist parameter in healthy Indian adults during COVID-19 pandemic and furthermore to analyse their relationship with age and gender. METHOD: Study population consisted of 80 adults of 18-60 years (58 men, 22 women), which was arbitrarily divided into two groups: Group A <30 years and Group B >31 years. RESULTS: GLS was higher in females (P<0.01) and in Group A (P<0.01). On the contrary GCS and GRS were higher in men (P=NS) and in Group B (P<0.01), at the mitral valve level. At the papillary muscle level GCS and GRS values are more in men (P<0.01) and in <30 years of age (P<0.01 and P<0.05 respectively). Furthermore, the values of numerous other strain parameters-GLSR, GCSR, GRSR, LGV, TV, TS, TSR, Shear, Shear rate, ROV and RV, reflected heterogeneous variation across gender and various age groups. Twist was greater in men and increased with increasing age (P<0.01). CONCLUSION: We have demonstrated a comprehensive data obtained in the current study utilizing 4D XStrain STE in healthy subjects. The LV speckle tracking software simultaneously provided 4D volumetric, strain, rotation and twist data in great detail. However, this distinctive technology has not been widely adopted and its evaluation is still limited to research applications. Therefore, further clinical studies are needed to validate our findings.

Echocardiographic Findings in Adolescents Presenting for Sports Clearance Following COVID-19

Background: Multiple studies have investigated cardiovascular effects associated with COVID-19 in collegiate and professional athletes. The incidence of cardiovascular abnormalities in adolescents seeking a return to sports following COVID-19 is not well known. We performed a comprehensive analysis of clinical and subclinical function in a cohort of post-COVID individuals seeking clearance for sports participation. We hypothesized that adolescent athletes after COVID-19 would have subclinical functional abnormalities. Methods: We reviewed outpatient transthoracic echocardiograms obtained between 11/01/2020 and 12/31/2020 for clearance for return to activity/sports of patients aged 12-18 with a history of mild or moderate COVID infection (COVID group). Adolescents from the pre-COVID era with complaints of chest pain, shortness of breath, palpitations, or syncope served as controls (pre-COVID group). Conventional echocardiographic metrics were ed from clinical reports;two investigators retrospectively used speckle tracking echocardiography to obtain left ventricular global longitudinal strain (LV GLS), LV global circumferential strain (GCS), right ventricular global longitudinal strain (RV GLS), and RV free wall strain (FWS). Upper limit of normal for GLS was -18%. Wilcoxon rank-sum test was used to evaluate differences between the groups, and Spearman's rho was used to evaluate correlations. Multivariable linear regression following multiple imputation of minimal missing data was performed to evaluate associations. Results: Thirty-eight COVID and 36 pre-COVID subjects were enrolled. There was no significant difference in the groups' age and gender distributions (Table 1). Median time since COVID diagnosis in that cohort was 33.5 days (IQR 22 - 64). Symptoms were reported in 68.4% of that group with a borderline or abnormal ECG in 23.7%;1 patient had depressed left ventricular ejection fraction (LVEF) and associated abnormal strain, and 8 had abnormal LV GLS despite normal LVEF based on our cut-off of -18%. The COVID group had decreased LV GLS, LV GCS, RV FWS, and RV GLS in comparison to the pre-COVID group (Table 1, Figure 1). Within the COVID cohort, controlling for age and gender, neither abnormal ECG nor presence of symptoms was associated with abnormal LV GLS or GCS. Time since COVID diagnosis was not associated with conventional echocardiographic or strain metrics. The COVID group continued to have worse LV GCS and RV GLS after controlling for age and gender;LV GLS and RV FWS no longer correlated with COVID status in multivariable analysis. Conclusion: In adolescents with prior mild or moderate COVID illness, ventricular function by conventional metrics is not categorically different from those without a COVID history. However, differences in myocardial strain suggest subclinical dysfunction. Future studies should elucidate whether these myocardial strain abnormalities persist and whether they are predictive of adverse outcomes in these patients.

The usefulness of speckle tracking echocardiography in identifying subclinical myocardial dysfunction in young adults recovered from mild COVID-19.

BACKGROUND: Myocardial strain assessed with speckle tracking echocardiography is a sensitive marker of cardiac dysfunction. Both left-ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were affected by severe SARS-CoV-2 infection. However, data about cardiac involvement in patients with asymptomatic/mild Coronavirus disease-19 (COVID-19) is still lacking. AIM: To evaluate myocardial function using LV-GLS and RV-LS in patients with previous asymptomatic/mild COVID-19. METHODS: Forty young adults without previously known comorbidities/cardiovascular risk factors and with a confirmed diagnosis of asymptomatic or paucisymptomatic SARS-CoV-2 infection were retrospectively included. A 2D-transthoracic echocardiogram with speckle tracking analysis was performed at least 3 months after the diagnosis. Forty healthy subjects, matched for age, sex, and body surface area in a 1:1 ratio were used as the control group. RESULTS: Left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and RV-LS were comparable between the two groups. LV-GLS was significantly lower in the cases compared to the control group (-22.7 ± 1.6% vs. -25.7 ± 2.3%; p < .001). Moreover, the prevalence of regional peak systolic strain below -16% in at least two segments was three times higher in patients with previous COVID-19 compared to controls (30% vs. 10%, p = .02). In multivariable logistic regression, previous COVID-19 infection was independently associated with reduced LV-GLS values (p < .001). CONCLUSION: SARS-CoV-2 infection may affect left ventricular deformation in 30% of young adult patients despite an asymptomatic or only mildly symptomatic acute illness. Speckle-tracking echocardiography could help early identification of patients with subclinical cardiac involvement, with potential repercussions on risk stratification and management.

The Evolving Role of Echocardiography During the Coronavirus Disease 2019 Pandemic

Coronavirus disease 2019 (COVID-19) has been associated with a wide spectrum of cardiovascular manifestations. Since the beginning of the pandemic, echocardiography has served as a valuable tool for triaging, diagnosing and managing patients with COVID-19. More recently, speckle-tracking echocardiography has been shown to be effective in demonstrating subclinical myocardial dysfunction that is often not detected in standard echocardiography. Echocardiographic findings in COVID-19 patients include left or right ventricular dysfunction, including abnormal longitudinal strain and focal wall motion abnormalities, valvular dysfunction and pericardial effusion. Additionally, some of these echocardiographic abnormalities have been shown to correlate with biomarkers and adverse clinical outcomes, suggesting an additional prognostic value of echocardiography. With increasing evidence of cardiac sequelae of COVID-19, the use of echocardiography has expanded to patients with cardiopulmonary symptoms after recovery from initial infection. This article aims to highlight the available echocardiographic tools and to summarize the echocardiographic findings across the full spectrum of COVID-19 disease and their correlations with biomarkers and mortality.

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.

Evolution of echocardiographic and cardiac magnetic resonance imaging abnormalities during follow-up in patients with multisystem inflammatory syndrome in children.

AIMS: Multisystem inflammatory syndrome in children (MIS-C) with cardiovascular manifestations are frequent. However, there is lacking evidence regarding cardiological follow-up of this cohort of patients. The aim of our study was to describe the early and mid-term cardiac abnormalities assessed by standard and speckle-tracking echocardiography (STE), and cardiac MRI (CMR). METHODS AND RESULTS: We enrolled 32 patients (21 male, 11 female), mean age 8.25 ± 4years, with diagnosis of MIS-C. During admission, all children underwent TTE, STE with analysis of left ventricle global longitudinal strain (GLS) and CMR. Patients underwent cardiological evaluation at 2 (T1) and 6 months (T2) after discharge. Cardiac MRI was repeated at 6 months after discharge. Mean left ventricular ejection fraction (LVEF) at baseline was 58.8 ± 10% with 10 patients (31%) below 55%. Speckle-tracking echocardiography showed reduced mean LV GLS (-17.4 ± 4%). On CMR, late gadolinium enhancement (LGE) with non-ischaemic pattern was evident in 8 of 23 patients (35%). Follow-up data showed rapid improvement of LVEF at T1 (62.5 ± 7.5 vs. 58.8 ± 10.6%, P-value 0.044) with only three patients (10%) below ≤ 55% at T1. Left ventricular (LV) GLS remained impaired at T1 (-17.2 ± 2.7 vs.-17.4 ± 4, P-value 0.71) and significantly improved at T2 (-19 ± 2.6% vs. -17.4 ± 4%, P-value 0.009). LV GLS was impaired (>-18%) in 53% of patients at baseline and T1, whereas only 13% showed persistent LV GLS reduction at T2. Follow-up CMR showed LGE persistence in 33.4% of cases. CONCLUSION: Early cardiac involvement significantly improves during follow-up of MIS-C patients. However, subclinical myocardial dysfunction seems to be still detectable after 6 months of follow-up in a not negligible proportion of them.

COVID-19 Myocarditis: Prognostic Role of Bedside Speckle-Tracking Echocardiography and Association with Total Scar Burden.

SARS-CoV2 infection, responsible for the COVID-19 disease, can determine cardiac as well as respiratory injury. In COVID patients, viral myocarditis can represent an important cause of myocardial damage. Clinical presentation of myocarditis is heterogeneous. Furthermore, the full diagnostic algorithm can be hindered by logistical difficulties related to the transportation of COVID-19 patients in a critical condition to the radiology department. Our aim was to study longitudinal systolic cardiac function in patients with COVID-19-related myocarditis with echocardiography and to compare these findings with cardiac magnetic resonance (CMR) results. Patients with confirmed acute myocarditis and age- and gender-matched healthy controls were enrolled. Both patients with COVID-19-related myocarditis and healthy controls underwent standard transthoracic echocardiography and speckle-tracking analysis at the moment of admission and after 6 months of follow-up. The data of 55 patients with myocarditis (mean age 46.4 ± 15.3, 70% males) and 55 healthy subjects were analyzed. The myocarditis group showed a significantly reduced global longitudinal strain (GLS) and sub-epicardial strain, compared to the control (p < 0.001). We found a positive correlation (r = 0.65, p < 0.0001) between total scar burden (TSB) on CMR and LV GLS. After 6 months of follow-up, GLS showed marked improvements in myocarditis patients on optimal medical therapy (p < 0.01). Furthermore, we showed a strong association between baseline GLS, left ventricular ejection fraction (LVEF) and TSB with LVEF at 6 months of follow-up. After a multivariable linear regression analysis, baseline GLS, LVEF and TSB were independent predictors of a functional outcome at follow-up (p < 0.0001). Cardiac function and myocardial longitudinal deformation, assessed by echocardiography, are associated with TSB at CMR and have a predictive value of functional recovery in the follow-up.

Right ventricular strain in in COVID-19 patients: a single-center experience

BACKGROUND: Assessment of right ventricular systolic function using strain imaging analysis from two-dimensional echocardiography has been identified to have powerful predictive value. Utilization of right ventricular strain may provide additional information in the management of COVID-19 patients. OBJECTIVE: To determine and analyze the right ventricular systolic function using longitudinal strain imaging among COVID-19 patients. METHOD: This is a prospective cohort study of the right ventricular function using speckle tracking echocardiography among COVID-19 patients. The study included two dimensional (2D) echocardiographic studies among 137 adult patients with laboratory-confirmed COVID-19 from September to November 2020. Analysis of Variance (ANOVA) was used to compare more than two groups with numerical data. Pearson Correlation was utilized to determine correlation between numerical variables. RESULTS: The results showed a total of 35 patients (25.54%) to have abnormal right ventricular free wall strain. The results showed that there was a significant direct correlation between right ventricular free wall strain and the echocardiographic parameters of tricuspid annular plane systolic excursion (TAPSE) (r = 0.277;p = 0.001), S' (r = 0.166;p = 0.050), right ventricular fractional area change (r = 0.298;p < 0.0001) and left ventricular ejection fraction (LVEF) (r = 0.176;p = 0.040). There was a significant inverse correlation noted between right ventricular free wall strain and the echocardiographic parameters of the tricuspid regurgitation (r=-0.284;p = 0.001), pulmonary arterial systolic pressure (r=-0.209;p = 0.014) and left atrial size (r=-0.209;p = 0.014). There was a significant difference in the right ventricular free wall strain according to the severity of COVID-19 infection (p = 0.032). Moreover, a significant difference was also noted between right ventricular free wall strain and mortality (p = 0.0001). The mean right ventricular free wall strain of patients who died was significantly lower than those who were discharged with a mean of 18.92% and 23.59% respectively. CONCLUSION: Right ventricular free wall strain using speckle tracking echocardiography, can be used for risk stratification for patients with COVID-19. It also showed that it is has significant correlation with the severity of the disease and mortality. These findings together with other conventional echocardiographic parameters, may provide clinicians additional information in the management of these patients.

Subclinical left and right ventricular dysfunction in COVID-19 recovered patients using speckle tracking echocardiography

Introduction: Myocardial injury during acute COVID-19 infection is well characterised however, its persistence during recovery is unclear. Purpose: We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricular (RV) free wall longitudinal strain and RV global longitudinal strain (RV-GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients (30-45 days post recovery) and studied its correlation with various parameters. Methods: of the 245 subjects screened, a total of 53 subjects recovered from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results: All the 53 subjects were symptomatic during COVID-19 illness and were categorized as mild: 27 (50.9%), moderate: 20 (37.7%) and severe: 6 (11.4%) COVID-19 illness. Reduced LV GLS was reported in 22 (41.5%), reduced RV-GLS in 23 (43.4%) and reduced RVFWS in 22 (41.5%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -20.3 ± 1.7%;moderate: -15.3 ± 3.4%;severe: -10.7 ± 5.1%;P < 0.0001). Similarly, RVGLS (mild: -21.8 ± 2.8%;moderate: -16.8 ± 4.8%;severe: -9.7 ± 4.6%;P < 0.0001) and RVFWS (mild: -23.0 ± 4.1%;moderate: -18.1 ± 5.5%;severe: -9.3 ± 4.4%;P < 0.0001) were significantly lower in subjects with severe COVID-19. Subjects with reduced LVGLS as well as RVGLS and RVFWS had significantly higher interleukin-6, C-reactive protein, lactate dehydrogenase and serum ferritin levels during index admission. Conclusions: Subclinical LV and RV dysfunction was seen in majority of COVID-19 recovered patients. Patients with severe disease during index admission had far lower LV and RVGLS as compared to mild and moderate cases. Our study highlights the need for close follow-up of COVID-19 recovered subjects in order to determine the long-term cardiovascular outcomes.

Evaluation of cardiac function by two-dimensional speckle tracking echocardiography in uncomplicated COVID-19 survivors

5COVID-19 is a multi-systemic infectious disease. Nearly 20-30% of hospitalized patients have evidence of acute myocardial involvement, portending a poorer prognosis. However, not much is known about the long-term cardiac effects of the disease. Also, there is a growing concern about the cardiac sequelae of COVID-19 among survivors. In this study, we aimed to investigate the long-term cardiac effects in patients with prior mild-moderate COVID-19 infection, using both conventional and speckle tracking echocardiographic imaging modalities. A total number of 58 patients who have been diagnosed with COVID-19 within the previous six months and 20 age-, sex- and risk factormatched healthy adults were included. All patients underwent a comprehensive echocardiographic examination. Both conventional and twodimensional speckle tracking echocardiographic measurements were done. Also, serum cardiac biomarkers were obtained on the day of echocardiographic examination. Compared with healthy controls, COVID-19 survivors had similar left and right ventricular systolic function at six months. Also, left and right atrial peak systolic strain values did not differ between the groups. Long-term cardiac sequelae of COVID-19 infection are still widely unknown, resulting in concern among survivors. This study is valuable in putting forth the unaffected systolic and diastolic myocardial function on long-term in uncomplicated COVID-19 cases and may decrease the survivors' anxiety and the number of unnecessary applications to cardiology clinics.