Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

Abstract

Purpose SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout the pandemic course in 2019, its morphological characterisation is still unclear. With this study, we aimed to characterise echocardiographic patterns of ventricular function in patients with COVID-19-associated myocardial injury. Methods We prospectively assessed 32 patients hospitalised with COVID-19 and presence or absence of elevated high sensitive troponin T (hsTNT+ vs. hsTNT-) by comprehensive three-dimensional (3D) and strain echocardiography. Results A minority (34.3%) of patients had normal ventricular function, whereas 65.7% had left and/or right ventricular dysfunction defined by impaired left and/or right ventricular ejection fraction and strain measurements. Concomitant biventricular dysfunction was common in hsTNT+ patients. We observed impaired left ventricular (LV) global longitudinal strain (GLS) in patients with myocardial injury (-13.9% vs. -17.7% for hsTNT+ vs. hsTNT-, p = 0.005) but preserved LV ejection fraction (52% vs. 59%, p = 0.074). Further, in these patients, right ventricular (RV) systolic function was impaired with lower RV ejection fraction (40% vs. 49%, p = 0.001) and reduced RV free wall strain (-18.5% vs. -28.3%, p = 0.003). Myocardial dysfunction partially recovered in hsTNT + patients after 52 days of follow-up. In particular, LV-GLS and RV-FWS significantly improved from baseline to follow-up (LV-GLS: -13.9% to -16.5%, p = 0.013; RV-FWS: -18.5% to -22.3%, p = 0.037). Conclusion In patients with COVID-19-associated myocardial injury, comprehensive 3D and strain echocardiography revealed LV dysfunction by GLS and RV dysfunction, which partially resolved at 2-month follow-up. Trial registration COVID-19 Registry of the LMU University Hospital Munich (CORKUM), WHO trial ID DRKS00021225.

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

“…In patients with COVID-19, E/e′ which is reflective of LV filling pressures was not found to be elevated in patients with elevated HsT or other cardiac biomarkers. 44,46,57 Further, E/e′ ratio was not significantly altered in the severe forms of COVID-19 compared with mild form or between survivors and non survivors. 44,53,55,57,70,71 Of note, in a study of COVID-19 patients that included 90% of patients on mechanical ventilation and 50% in prone position showed that E/e′ ratio was significantly higher in non-survivors, and it was a predictor of mortality on univariate but not on multivariate analysis.…”

“…44,46,57 Further, E/e′ ratio was not significantly altered in the severe forms of COVID-19 compared with mild form or between survivors and non survivors. 44,53,55,57,70,71 Of note, in a study of COVID-19 patients that included 90% of patients on mechanical ventilation and 50% in prone position showed that E/e′ ratio was significantly higher in non-survivors, and it was a predictor of mortality on univariate but not on multivariate analysis. 52 However, two reports demonstrated that E/e′ ratio may be significantly higher in critically ill patients compared with healthy volunteers and milder forms of the disease.…”

“…47,55,56 However, RVFAC was found to be lower in COVID-19 patients with myocardial injury when compared with COVID-19 patients without myocardial injury. 57,58 Also, RVFAC does not seem to be significantly decreased even in COVID-19 patients with acute cor-pulmonale as compared with those with no acute cor-pulmonale. 59…”

“…Echocardiographic follow up after acute COVID-19 LV and RV dysfunction, whether it is clinical or subclinical resolves in most patients post resolution of acute COVID-19. 44,50,57,85 In a study by Churchill et al, a follow up ECHO was done in 11 patients after a median of 14 days post-acute COVID-19. The resolution of previously noted LV dysfunction and/or WMA was ascertained in 9/11 patients.…”

Cardiac complications during the active phase of COVID-19: review of the current evidence

“…Other studies suggest that HF incidence may be even higher. Bieber et al observed that left ventricular dysfunction (both systolic and/or diastolic) and systolic right ventricular dysfunction occurred in 56% of their total cohort (116 pts) and more frequently in patients with increased troponin (88.8% vs. 14.3%, p < 0.001) [71]. Moreover, this complication occurs regardless of a prior history of CD [72], suggesting a direct role of SARS-CoV-2 infection in its pathogenesis.…”