Progressive left and right heart dysfunction in coronavirus disease-19: Prospective echocardiographic evaluation

Abstract

Aims Cardiac dysfunction in coronavirus disease-19 (COVID-19) has been reported during acute phase but serial changes have not been well studied. To determine serial changes in type and severity of echocardiographic left and right heart functions we performed a prospective study. Methods and results Successive COVID-19 patients at discharge from the hospital from June to December 2020 were enrolled. Clinical details were obtained and echocardiography was performed using Philips IE33X-Matrix. Follow-up evaluation was performed after 3 months. In total, 1789 COVID-19 patients were evaluated. Baseline echocardiography was performed in 1000 eligible patients (men 611, women 389). Mean age was 50.2 ± 15 years, hypertension was in 44.0%, diabetes in 49.4%, and coronary disease in 10.8%. COVID-19 was mild in 47.0%, moderate in 39.5%, and severe in 13.5%. Baseline cardiac parameters were more impaired in severe vs. moderate or mild COVID-19. At 3 months, in 632 patients where baseline and follow-up data were available, decline was observed in select left [left ventricular internal diameter in diastole +0.9 ± 0.2 mm, left atrial volume +7.6 ± 0.1 mL/m2, mitral E/e′ +4.8 ± 0.1, and left ventricular ejection fraction (LVEF) −3.7 ± 0.2%] and right [right ventricular internal diameter in diastole +2.1 ± 0.1 mm, right atrial internal dimension +1.6 ± 0.1 mm, tricuspid Vmax +1.0 ± 0.1 cm, and tricuspid annulus plane systolic excursion (TAPSE) −2.7 ± 0.2 mm] heart variables (P < 0.001). Compared to mild COVID-19, decline was significantly greater in moderate/severe disease, LVEF −1.1 ± 0.3 vs. −3.8 ± 0.3%; mitral E/e′ +3.2 ± 0.1 vs. +4.8 ± 0.1, tricuspid Vmax +0.3 ± 0.1 vs. +1.0 ± 0.1 cm, and TAPSE −0.7 ± 0.2 vs. −2.7 ± 0.2 mm (P < 0.001). Conclusion This study shows impaired cardiac functions in severe and moderate COVID-19 compared to mild at hospital discharge and progressive decline in left and right heart functions at 3 months. Impairment is significantly greater in patients with moderate to severe disease.

Risk of Cardiovascular Events After COVID-19

“…A prospective echocardiographic study of hospitalized, symptomatic patients with COVID-19 reported a decrease in both left and right-sided cardiac function 3 months after hospital discharge. 20 Preliminary findings of the prospective longitudinal study C-MORE (Capturing MultiORgan Effects of COVID-19) 21 showed that more than half of the patients experienced symptoms at 6 months after COVID-19, limiting their ability to exercise. C-MORE investigators also noted a dissociation between symptoms and objective measures of CV health.…”

COVID-19 and Cardiovascular Diseases: From Cellular Mechanisms to Clinical Manifestations

“…More than 50% of the 50 patients who recovered from COVID-19 had reduced right ventricular ejection fraction [134]. Chaturvedi et al classified 1,000 patients with COVID-19 into mild, moderate, and severe according to preexisting cardiovascular disease and the degree of COVID-19 infection and found that moderate to severe cases showed extreme cardiac damage than mild COVID-19 cases, with progressive decline in cardiac function over 3 months (LVEF −1.1 ± 0.3 vs. −3.8 ± 0.3%; mitral E/e' +3.2 ± 0.1 vs. +4.8 ± 0.1; tricuspid Vmax + 0.3 ± 0.1 vs. +1.0 ± 0.1 cm; TAPSE −0.7 ± 0.2 vs. −2.7 ± 0.2 mm (P < 0.001)) [135]. Cardiac structure (left ventricular volume, mass, and atrial area), function (ejection fraction, global longitudinal shortening, and aortic dilation), tissue characteristics (T1, T2, extracellular volume fraction mapping, and late gadolinium enhancement), and biomarkers (troponin, Nterminal pro-B-type natriuretic peptide) in patients with mild symptoms (troponin-negative, asymptomatic, or mildly symptomatic) after recovery from COVID-19 were not significantly different from those in COVID-19 seronegative healthy controls [136].…”

Myocardial Work in Patients Hospitalized With COVID‐19: Relation to Biomarkers, COVID‐19 Severity, and All‐Cause Mortality

“…Several ailments have been described following COVID‐19 infection, 42 and although RV function has been reported to both improve and deteriorate after recovery of COVID‐19 infection, LV function does not seem to improve and may even deteriorate, particularly in moderate‐severe infection but also in mild cases. 43 , 44 Hence, the consequences of COVID‐19 go beyond the immediate infection, and the clinical implications of persistent LV dysfunction need to be explored further.…”