Is there a unique cardiac deformation behaviour in COVID-patients? The SARS-2-DEFORM Study

ABSTRACT

Myocardial dysfunction is common and associated with worse outcomes in patients with ARDS, pulmonary embolism or severe sepsis due to pulmonary hypoxic vasoconstriction. Thrombotic events, myocarditis and endothelial dysfunction may contribute to these effects in COVID- 19 infection. The evaluation of myocardial function can provide prognostic information regarding the severity of a current COVID-19 infection, but scarce data available on the role of Deformation Indices obtained by Speckle Tracking Analysis to describe unique features of myocardial dysfunction in COVID-19 pneumonitis. AIMS: to evaluate the value of ventricular and atrial Deformation Imaging in patients with COVID- 19 infection and hypoxia who had preserved systolic function in comparison with age-, gender-, BSA, hypoxia-matched control subjects with respiratory disease on oxygen therapy, thus excluding the effects of pulmonary vasoconstriction. We also assessed the impact of biochemical and inflammatory markers on the Echo-Indices. METHODS: 21 patients with PCR-confirmed COVID-pneumonitis (15 males, age60.1 ± 16.1yrs, range43-89) and 31 control, PCR-negative subjects (age62.8 ± 15.5yrs, range22-92) on oxygen with matched biometric data were compared. 2 examiners, blinded to the clinical data performed off-line standard Echocardiographic assessment and Deformation Imaging by 2D-Speckle Tracking Analysis with the TomTec Arena software package (Unterschleissheim, Germany) in both ventricles and atria. Plasma chemistry data were compared between the groups. RESULTS: No differences found in the biometric data and the cardiac chamber sizes between the groups. The global systolic strain indices were reduced in the COVID-group in the LV, but not the EF (LV-GLS -13.6 ± 2.9 vs -16 ± 1.1%, LV-GCS -24.8 ± 2.4 vs -28.9 ± 2.8%, p = 0.001, LVEF 61 ± 3.7 vs 60.7 ± 4.9%, p = NS), and these were reduced in the RV and RA, but not the TAPSE and TDI-S' when compared to the controls (RV-FWS -12.3 ± 2.9 vs -16.2 ± 1.5%, RV-GLS -14.6 ± 3.4 vs -17.1 ± 1.7%, RASr 18.5 ± 6 vs 22.3 ± 4.8% p = 0.005. Interestingly, the dispersion of contraction was increased in the COVID-patients in both the LV (LV-SD 416.2 ± 81.8 vs 309.8 ± 69.8ms, p < 0.001) and the RV and the RA (RV-SD 414.9 ± 117 vs 303.8 ± 61ms, RA-SD 33.5 ± 6.7 vs 26.1 ± 4.7ms, p < 0.001). The right heart indices correlated well with the biochemical data (RV-FWS and RV-SD with Ferritin r = 0.54 and -0.46, p = 0.003, RASr with GLS r = 0.64, p = 0.002, RA-SD with Troponin, p = 0.01 and with the RV-coupling Index r = 0.72, p = 0.02). CONCLUSIONS: Myocardial dysfunction is common among severely ill and hypoxic COVID-19 patients. The conventional Echo-parameters of systolic function or pulmonary pressures do not appear being specific but the Deformation Indices can provide tools to detect unique changes of the myocardial function and dys-synchrony imposed by the COVID-19 infection, independently from the impact of hypoxia or raised pulmonary pressures, hence they can predict outcome more accurately.