Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge

Abstract

Aim To study changes in clinical and echocardiographic parameters in patients after documented COVID-19 pneumonia at 3 months and one year following discharge from the hospital. Material and methods The study included 116 patients who have had documented COVID-19 pneumonia. Patients underwent a comprehensive clinical evaluation at 3 months ± 2 weeks (visit 1) and at one year ± 3 weeks after discharge from the hospital (visit 2). Mean age of the patients was 49.0±14.4 years (from 19 to 84 years); 49.6 % were women. Parameters of global and segmentary longitudinal left ventricular (LV) myocardial strain were studied with the optimal quality of visualization during visit 1 in 99 patients and during visit 2 in 80 patients.Results During the follow-up period, the incidence rate of cardiovascular diseases (CVD) increased primarily due to development of arterial hypertension (AH) (58.6 vs. 64.7 %, р=0.039) and chronic heart failure (CHF) (35.3% vs. 40.5 %, р=0.031). Echocardiography (EchoCG) showed decreases in values of end-diastolic dimension and volume, LV end-systolic and stroke volumes (25.1±2.6 vs. 24.5±2.2 mm /m2, p<0.001; 49.3±11.3 vs. 46.9±9.9 ml /m2, p=0.008; 16.0±5.6 vs. 14.4±4.1 ml /m2, p=0.001; 36.7±12.8 vs. 30.8±8.1 ml /m2, p<0.001, respectively). LV external short-axis area (37.1 [36.6–42.0] vs. 38.7 [35.2–43.1] cm2, р=0.001) and LV myocardial mass index calculated with the area-length formula (70.0 [60.8–84.0] vs. 75.4 [68.2–84.9] g /m², р=0.024) increased. LV early diastolic filling velocity (76.7±17.9 vs. 72.3±16.0 cm /sec, р=0.001) and lateral and septal early diastolic mitral annular velocities decreased (12,10±3,9 vs. 11.5±4.1 cm /sec, р=0.004 and 9.9±3.3 vs. 8.6±3.0 cm /sec, р<0.001, respectively). The following parameters of LV global longitudinal (–20.3±2.2 vs. –19.4±2.7 %, р=0.001) and segmental strain were impaired: apical segments (anterior, from –22.3±5.0 to –20.8±5.2 %, р=0.006; inferior, from –24.6±4.9 to –22.7±4.6, р=0.003; lateral, from –22.7±4.5 to –20.4±4.8 %, р<0.001; septal, from –25.3±4.2 to –23.1±4.4 %, р<0.001; apical, from –23.7±4.1 to –21.8±4.1 %, р<0.001), mid-cavity (anteroseptal, from –21.1±3.3 to –20.4±4.1 %, р=0.039; inferior, from –21.0±2.7 to –20.0±2.9 %, р=0.039; lateral, from –18.4±3.7 to –17.6±4.4 %, р=0.021). RV basal and mid-cavity sphericity indexes increased (0.44±0.07 vs. 0.49±0.07 and 0.37±0.07 vs. 0.41±0.07, respectively, р<0.001 for both). A tendency for increased calculated pulmonary arterial systolic pressure (22.5±7.1 and 23.3±6.3 mm Hg, р=0.076) was observed. Right ventricular outflow tract velocity integral decreased (18.1±4.0 vs. 16.4±3.7 cm, р<0.001).Conclusion Patients after COVID-19 pneumonia one year after discharge from the hospital, compared to the follow-up data 3 months after the discharge, had an increased incidence of CVD, primarily due to the development of AH and CHF. EchoCG revealed changes in ventricular geometry associated with impairment of LV diastolic and systolic function evident as decreases in LV global longitudinal strain and LV myocardial apical and partially mid-cavity strain.

Associations of arterial hypertension and the severity of the course of a new coronavirus infection

“…В свою очередь ремоделирование миокарда на фоне АГ является серьезным предиктором смертности от ССЗ [17]. Существуют данные, что у реконвалесцентов инфекции COVID-19 наблюдается увеличение внешней и внутренней площади МЛЖ и ММЛЖ, что ведет к увеличению частоты ССЗ [18]. Согласно полученным нами данным, ИММЛЖ в пересчете на рост у пациентов Т а б л и ц а 2…”

Factors affecting the severity of COVID-19 and the development of complications

“…Compared to three months post-discharge, a higher prevalence of cardiovascular diseases was observed one year after recovery, which is driven primarily by the development of arterial hypertension and chronic heart failure. Echocardiography reveals changes in ventricular geometry accompanied by a decline in diastolic and systolic function of the left ventricle (LV), including reduced global longitudinal strain and deformation in the apical myocardium and partially the mid myocardial segments [108]. In the long term, patients recovered from the COVID-pneumonia can develop alterations in the right heart chambers.…”

Severe Covid‐19 and acute pulmonary hypertension: 24‐month follow‐up regarding mortality and relationship to initial echocardiographic findings and biomarkers

“…[4][5][6][7][8] In our previous study on this topic, we found an incidence of aPH, based on echocardiographic criteria, of 39% in Covid-19 patients admitted to intensive care (ICU) and that early mortality (21 days) was increased more than 6-fold compared to patients without signs of aPH. 4 In previous follow-up reports on hospitalized Covid-19 patients, 9,10 the issue of aPH has not been reported in any detail.…”

“…In previous follow‐up reports on hospitalized Covid‐19 patients, 9,10 the issue of aPH has not been reported in any detail. Against the results of our previous study, we hypothesized that mortality may continue to be elevated after 1 month in patients with Covid‐19 and aPH.…”