Echocardiographic Assessment in Patients Recovered from Acute COVID-19 Illness

Luke Stefani; Paula Brown; Monica Gerges; Peter Emerson; Aaisha Ferkh; Kristina Kairaitis; Nicole Gilroy; Mikhail Altman; Liza Thomas

doi:10.3390/jcdd10080349

Echocardiographic Assessment in Patients Recovered from Acute COVID-19 Illness

J Cardiovasc Dev Dis. 2023 Aug 15;10(8):349. doi: 10.3390/jcdd10080349.

Authors

Luke Stefani^{1

2}, Paula Brown², Monica Gerges², Peter Emerson^{1

2}, Aaisha Ferkh^{1

2}, Kristina Kairaitis^{1

3}, Nicole Gilroy^{1

4}, Mikhail Altman^{1

2}, Liza Thomas^{1

2

5}

Affiliations

¹ Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia.
² Cardiology Department, Westmead Hospital, Westmead 2145, Australia.
³ Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead 2145, Australia.
⁴ Department of Infectious Diseases, Westmead Hospital, Westmead 2145, Australia.
⁵ Southwestern Clinical School, University of New South Wales, Kensington 2052, Australia.

Abstract

Coronavirus (COVID-19) infections have spread rapidly worldwide and posed an immense public health problem. COVID-19 infection can affect the cardiovascular system both acutely and in patients followed up some period after COVID-19 infection. The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by echocardiography in COVID-19 recovered patients (hospitalized and non-hospitalized). Forty-two patients who recovered from COVID-19 but had ongoing symptoms were included in this retrospective observational cross-sectional study. Patients were followed-up at a median time of 112 days from confirmed COVID-19 diagnosis and a comprehensive echocardiogram was performed. COVID-19 patients were age- and sex-matched to healthy controls. Traditional TTE parameters and advanced echocardiographic parameters including two-dimensional LV global longitudinal strain (GLS) and RV free wall strain (FWS) were measured. LV volumes and LV ejection fraction were similar in COVID-19 patients and controls; however, LV GLS was significantly worse in the COVID-19 group (p = 0.002). Similarly, RV volumes and traditional RV function parameters were similar, but RV FWS (p = 0.009) and RV global strain (p = 0.015) were reduced. Alterations in LV and RV strain were observed in both hospitalized and non-hospitalized patients. In the subset of COVID-19 patients without any co-morbidities (n = 30), LV GLS remained reduced compared to controls. According to multivariate analysis, COVID-19 infection was the only independent determinant of reduced LV GLS (p = 0.012), while COVID-19 infection, diastolic blood pressure, and RV fractional area change were determinants of RV FWS. In this observational study, prior COVID-19 infection demonstrated LV dysfunction in patients with persistent symptoms. Abnormal LV strain was evident in both hospitalized and non-hospitalized patients, suggesting that these changes are independent of the severity of COVID-19 infection at presentation. The use of LV GLS in COVID-19 patients could have potential clinical utility to support the indication for cardiac magnetic resonance imaging in patients with possible COVID-19 related myocarditis. Future longitudinal studies are needed to evaluate its correlation with adverse cardiovascular events.

Keywords: COVID-19; GLS; RV free wall strain; echocardiography.

Grants and funding

This research received no external funding.