Alterations of Left Ventricular Function Persisting during Post-Acute COVID-19 in Subjects without Previously Diagnosed Cardiovascular Pathology

Abstract

(1) Background: Coronavirus infection (Covid-19) has emerged as a severe medical condition, associated with high pulmonary morbidity and often with cardiovascular (CV) complications. This study aims to evidence the persistence of left ventricular (LV) systolic function (LV-SF) alterations and diastolic dysfunction (DD) in COVID-19 patients without history of cardiovascular (CV) diseases by transthoracic echocardiography (TTE). (2) Methods: 125 patients, aged under 55 years, hospitalized during the first outbreak of Covid-19 for moderate pneumonia, underwent a comprehensive cardiologic examination and TTE at 6–10 weeks after discharge. Their initial in-hospital laboratory data and thorax computer tomography (TCT) were accessed from the electronic database of the hospital. (3) Results: with TTE, we documented alterations of LV-SF and DD in 8.8% of patients and in 16.8% only patterns of DD, statistically correlated with the initial levels of creatin-kinase (CK-MB) and inflammatory factors. Multivariate regression analysis evidenced that CK-MB levels, age, and body mass index (BMI) are responsible for 65% of LV-SF decrease. (4) Conclusions: Alterations of LV-SF and DD are frequent in post-acute COVID-19 infection and are responsible for the persistence of symptoms. Elevated myocardial necrosis markers during the acute phase seem to predict subsequent alteration of cardiac performance.

Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID‐19: A systematic review

“…50,53,54,60 LV diastolic dysfunction was observed in 16%, and systolic dysfunction in 10% of COVID-19 patients. 46,61…”

“…But DD seems to be more common than systolic dysfunction in patients with COVID-19(16% vs 10%). 46,61…”

“…For instance, in a study of 125 survivors, with moderate pneumonia, who underwent follow up ECHO within 6-10 weeks, RV dilation was reported in 14%, isolated DD in 16% and 8.8% had both LV systolic and diastolic dysfunction, these correlated with elevation of CKMB during initial hospitalization. 61 Also, in a study that included 28 patients with elevated troponin (myocardial injury) during hospital stay and 46 patients with no elevated troponin, 37.8% of the whole cohort with 57.1% of the myocardial injury group and 26.1% of the no myocardial injury group had impaired LVGLS defined as less than -18% after a mean follow up of 4 weeks, LVEF was preserved in both groups but significantly lower in the group with myocardial injury during hospitalization. 86 Among patients with COVID 19, ECHO can be an important tool to diagnose and prognosticate patients regardless of their clinical severity.…”

Evaluation of the right and left ventricular functions of patients that recovered from COVID‑19 at home

“…In a study conducted with patients hospitalized with a diagnosis of COVID-19, although there was no difference in LVEF and LV diastolic dysfunction (E/a') between those that died and those that survived, it was reported that MAPSE was lower in the former, and it was an independent predictor of mortality 6 . In a study including patients who had been hospitalized with a diagnosis of mild to moderate COVID-19 pneumonia and discharged, who had no known history of cardiovascular disease, echocardiography was performed in the postacute COVID phase (<12 weeks), and LV dysfunction was detected in 8.8% of patients and diastolic dysfunction in 16.8% 19 . In another study, patients hospitalized with a diagnosis of COVID- 19 and discharged underwent echocardiography one month after the first detection of infection, and the RV and LV functions did not vary between the control and patient groups 20 .…”

Acute and Chronic Effects of COVID-19 on the Cardiovascular System

“…One of the frequent observations was the LV's diastolic dysfunction, which was found in up to 16% of COVID-19 patients [64]. A reduced LV ejection fraction (LVEF) was less common than diastolic dysfunction, with a reported prevalence of 10% [65]. Wall motion abnormalities were reported in 14 to 26% of the COVID-19 patients who underwent echocardiography.…”