Alteration in follow-up echocardiographic indices in patients with COVID-19: a prospective cohort study (preprint)

ABSTRACT

Background Cardiac problems are frequent (20 to 25%) with COVID-19 and are associated with cardiac complications and in-hospital mortality. Existing research on the echocardiographic examination of COVID-19 focuses mostly on hospitalized patients with severe symptoms and in the acute phase of the disease, leaving out of the spotlight non-hospitalized individuals with mild symptoms. In this study, we wanted to determine the long-term influence of both severe and non-severe COVID-19 on echocardiographic changes. Methods This prospective cohort study was conducted during Iran's third COVID-19 wave in November 2020 among healthcare workers with a history of COVID-19 but otherwise healthy. Initially, a total of 100 patients underwent the primary echocardiographic examination 6 to 8 weeks following COVID-19 onset, and 6 months after the COVID-19 diagnosis, 64 subjects underwent the secondary echocardiographic evaluations. Based on clinical or radiological evidence, individuals were categorized into two groups of non-severe and severe COVID-19. Results Of 64 participants, 42 (65.6%) were women. The patients ' mean age was 40.4±8.1 years. In the non-severe COVID-19 group, among left ventricular (LV) echocardiographic indices, stroke volume index and ejection fraction increased significantly (24.7±4.1 cc/m2 vs. 29.7±7.0 cc/m2, p-value<0.001 and 61.9% [59.8-64.5] vs. 63.8% [58.2-68.9], p-value=0.029, respectively). Among right ventricular indices, free-wall global longitudinal strain decreased significantly in the secondary echocardiogram (-32.3±4.6% vs. -28.8±5.8%, p-value=0.002). In the severe COVID-19 group, from LV echocardiographic indices, global longitudinal strain increased significantly over the follow-up period (-20% [-21.4- -19] vs. -23.9% [-25.3--21.9], p-value=0.004) and from RV indices, the fractional area change showed a significant decrease (47.2% [42.3-52.2] vs. 36.4% [31.1-45], p-value=0.002). Conclusion Although some patterns of significant change were seen among echocardiographic indices, COVID-19, regardless of severity, did not lead to cardiac impairment in an otherwise healthy population. The current results may not present the outcomes of older adults or with a history of cardiac problems against COVID-19.