Left ventricular global longitudinal strain in identifying subclinical myocardial dysfunction among patients hospitalized with COVID-19

Hezzy Shmueli; Maulin Shah; Joseph E Ebinger; Long-Co Nguyen; Fernando Chernomordik; Nir Flint; Patrick Botting; Robert J Siegel

doi:10.1016/j.ijcha.2021.100719

Left ventricular global longitudinal strain in identifying subclinical myocardial dysfunction among patients hospitalized with COVID-19

Int J Cardiol Heart Vasc. 2021 Feb:32:100719. doi: 10.1016/j.ijcha.2021.100719. Epub 2021 Jan 25.

Authors

Hezzy Shmueli¹, Maulin Shah¹, Joseph E Ebinger¹, Long-Co Nguyen¹, Fernando Chernomordik^{1

2

3}, Nir Flint^{1

4}, Patrick Botting¹, Robert J Siegel¹

Affiliations

¹ Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
² Pulmonary and Critical Care Medicine Division, Cedars Sinai Medical Center, Los Angeles, CA, USA.
³ Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴ Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Abstract

Background: The incidence of acute cardiac injury in COVID-19 patients is very often subclinical and can be detected by cardiac magnetic resonance imaging. The aim of this study was to assess if subclinical myocardial dysfunction could be identified using left ventricular global longitudinal strain (LV-GLS) in patients hospitalized with COVID-19.

Methods: We performed a search of COVID-19 patients admitted to our institution from January 1st, 2020 to June 8th, 2020, which revealed 589 patients (mean age = 66 ± 18, male = 56%). All available 60 transthoracic echocardiograms (TTE) were reviewed and off-line assessment of LV-GLS was performed in 40 studies that had sufficient quality images and the views required to calculate LV-GLS. We also analyzed electrocardiograms and laboratory findings including inflammatory markers, Troponin-I, and B-type natriuretic peptide (BNP).

Results: Of 589 patients admitted with COVID-19 during our study period, 60 (10.1%) underwent TTE during hospitalization. Findings consistent with overt myocardial involvement included reduced ejection fraction (23%), wall motion abnormalities (22%), low stroke volume (82%) and increased LV wall thickness (45%). LV-GLS analysis was available for 40 patients and was abnormal in 32 patients (80%). All patients with LV dysfunction had elevated cardiac enzymes and positive inflammatory biomarkers.

Conclusions: Subclinical myocardial dysfunction as measured via reduced LV-GLS is frequent, occurring in 80% of patients hospitalized with COVID-19, while prevalent LV function parameters such as reduced EF and wall motion abnormalities were less frequent findings. The mechanism of cardiac injury in COVID-19 infection is the subject of ongoing research.

Keywords: AV, atrioventricular; BNP, B-type natriuretic peptide; CMRI, cardiac magnetic resonance imaging; COPD, chronic obstructive pulmonary disease; COVID-19; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; ECG, electrocardiogram; Echocardiography; Global longitudinal strain; HTN, hypertension; ICU, intensive care unit; IL-6, interleukin-6; LA, left atrium; LDH, lactate dehydrogenase; LV, left ventricle; LV-GLS, left ventricular global longitudinal strain; LVEF, left ventricular ejection fraction; LVOT, left ventricular outflow tract; RV, right ventricle; SARS, severe acute respiratory syndrome; T2DM, type-2 diabetes mellitus; TAPSE, tricuspid annular plane systolic excursion; TTE, transthoracic echocardiogram; VTI, velocity-time integral.