Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities

Gergely Rácz; Hedvig Takács; Árpád Kormányos; Bianka Polestyuk; János Borbás; Nándor Gyenes; Noémi Schvartz; Gergely Németh; Zsigmond Tamás Kincses; Róbert Sepp; Viktória Nagy

doi:10.3390/diagnostics12081941

Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities

Diagnostics (Basel). 2022 Aug 11;12(8):1941. doi: 10.3390/diagnostics12081941.

Affiliations

¹ Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary.
² Department of Radiology, University of Szeged, 6725 Szeged, Hungary.

Abstract

Although the clinical manifestations of SARS-CoV-2 viral infection affect mainly the respiratory system, cardiac complications are common and are associated with increased morbidity and mortality. While echocardiographic alterations indicating myocardial involvement are widely reported in patients hospitalized for acute COVID-19 infection, much fewer data available in non-hospitalized, mildly symptomatic COVID-19 patients. In our work, we aimed to investigate subclinical cardiac alterations characterized by parameters provided by advanced echocardiographic techniques following mild SARS-CoV-2 viral infection. A total of 86 patients (30 males, age: 39.5 ± 13.0 yrs) were assessed 59 ± 33 days after mild SARS-CoV-2 viral infection (requiring no hospital or <5 days in-hospital treatment) by advanced echocardiographic examination including 2-dimensional (2D) speckle tracking echocardiography and non-invasive myocardial work analysis, and were compared to an age-and sex-matched control group. Altogether, variables from eleven echocardiographic categories representing morphological or functional echocardiographic parameters showed statistical difference between the post-COVID patient group and the control group. The magnitude of change was subtle or mild in the case of these parameters, ranging from 1−11.7% of relative change. Among the parameters, global longitudinal strain [−20.3 (−21.1−−19.0) vs. −19.1 (−20.4−−17.6) %; p = 0.0007], global myocardial work index [1975 (1789−2105) vs. 1829 (1656−2057) Hgmm%; p = 0.007] and right ventricular free wall strain values (−26.6 ± 3.80 vs. −23.8 ± 4.0%; p = 0.0003) showed the most significant differences between the two groups. Subclinical cardiac alterations are present following even mild SARS-CoV-2 viral infection. These more subtle alterations are difficult to detect by routine echocardiography. Extended protocols, involving speckle-tracking echocardiography, non-invasive measurement of cardiac hemodynamics, and possibly myocardial work are necessary for detection and adequate follow-up.

Keywords: SARS-CoV-2; echocardiography; myocardial injury; myocardial work.

Grants and funding

The research was funded by the “Hetényi Géza” grant of the Faculty of Medicine, University of Szeged provided to R.S. The publication of the manuscript was funded by the MED-EN TRADE KFT. (2400 Dunaújváros, Petőfi utca 63).