Recovery of cardiac function following <scp>COVID</scp>‐19 – <scp>ECHOVID</scp>‐19: a prospective longitudinal cohort study

Lassen, Mats Christian Højbjerg; Skaarup, Kristoffer Grundtvig; Lind, Jannie Nørgaard; Alhakak, Alia Saed; Sengeløv, Morten; Nielsen, Anne Bjerg; Simonsen, Jakob Øystein; Johansen, Niklas Dyrby; Davidovski, Filip Soeskov; Christensen, Jens Peter; Bundgaard, Henning; Hassager, Christian; Jabbari, Reza; Carlsen, Jørn; Kirk, Ole; Lindholm, Matias Greve; Kristiansen, Ole Peter; Nielsen, Olav Wendelboe; Ulrik, Charlotte Suppli; Sivapalan, Pradeesh; Gislason, Gunnar; Møgelvang, Rasmus; Jensen, Gorm; Schnohr, Peter; Søgaard, Peter; Solomon, Scott D.; Iversen, Kasper; Jensen, Jens Ulrik Stæhr; Schou, Morten

doi:10.1002/ejhf.2347

Cited by 49 publications

(42 citation statements)

References 27 publications

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“…4 COVID-19 itself is associated with both systolic and diastolic left ventricular dysfunction, pulmonary hypertension, and right ventricular dysfunctioneven in patients without known pre-existing CHF 5 and in asymptomatic patients. 6 These disease effects may further contribute to a worse prognosis in patients with pre-existing CHF. It is not known how the aetiology of CHF or baseline ejection fraction (EF) is associated with outcome in patients with severe COVID-19 admitted to the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Association of chronic heart failure with mortality in old intensive care patients suffering from Covid‐19

et al. 2022

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Aims Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID‐19). This prospective international multicentre study investigates the role of pre‐existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID‐19. Methods and results Patients with pre‐existing CHF were subclassified as having ischaemic or non‐ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre‐existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5–2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5–1.5; P = 0.137]. More patients suffered from pre‐existing ischaemic than from non‐ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non‐ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9–1.0; P = 0.128). Conclusions In critically ill older COVID‐19 patients, pre‐existing CHF was not independently associated with 30 day mortality. Trial registration number: NCT04321265.

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Section: Introductionmentioning

confidence: 99%

Association of chronic heart failure with mortality in old intensive care patients suffering from Covid‐19

et al. 2022

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“…Right ventricular diameter was also correlated with mortality rates [ 40 , 43 ]. Most studies suggest that both right ventricular and left ventricular function improve at follow-up [ 42 , 44 ], although there is also data that indicate that left ventricular function can remain impaired [ 44 ]. IL-6 levels could predict right ventricular systolic dysfunction in patients with COVID-19 [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term cardio-vascular risk assessment in chronic kidney disease and kidney transplanted patients following SARS-COV-2 disease: protocol for multi-center observational match controlled trial

et al. 2022

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Background The coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produced a pandemic since March 2020 by affecting more than 243 million people with more than 5 million deaths globally. SARS-CoV-2 infection is produced by binding to angiotensin-converting enzyme, which among other sites is highly expressed in the endothelial cells of the blood vessels, pericytes and the heart, as well as in renal podocytes and proximal tubular epithelial cells. SARS-CoV-2 and cardiovascular disease (CVD) are interconnected by risk factors association with an increased incidence of the disease and by determining de novo cardiac complications. At the same time, COVID-19 disease can lead to acute kidney injury directly, or due to sepsis, multi-organ failure and shock. Therefore, the pre-existence of both CVD and chronic kidney disease (CKD) is linked with a higher risk of severe disease and worse prognosis. Methods The main aim of this study is to assess the CV risk in a CKD (stage 3 to 5), dialysis and kidney transplanted population, following SARS-CoV-2 infection, with focus on the endothelial dysfunction as compared to a control group of matched patients. By using clinical evaluation, flow-mediated dilatation, carotid-femoral pulse wave velocity, intima-media thickness, echocardiographic parameters, lung ultrasound, bioimpedance spectroscopy and a series of novel biomarkers, the investigators will determine the long-term impact of this disease on CV and renal outcomes. Discussion This study will address the challenges and implications in long-term CV sequeale of COVID-19 and focus on a better understanding of the underlying mechanisms and possible therapeutic options. Trial registration Patient enrolment in the trial started in January 2021 and is expected to finish at the end of 2022. The study can be found on ClinicalTrials.gov database with NCT05125913 identifier. Registered on 18 November 2021 - Retrospectively registered.

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“…In addition, the study by Ozer et al was done a month after acute disease and as part of a routine follow-up and not symptom driven. Recently, two important reports by Lassen et al and Baruch et al showed no significant improvement in LV GLS in patients after COVID-19, moreover, in some patients there was a deterioration in LV GLS [ 32 , 33 ]. The mechanism for acute and persisting subclinical LV dysfunction is unknown, however MRI findings suggest adverse remodeling after myocarditis that may be detected by strain imaging.…”

Section: Discussionmentioning

confidence: 99%

Subclinical Myocardial Dysfunction in Patients Recovered from COVID-19 Disease: Correlation with Exercise Capacity

Shimoni

Korenfeld

Goland

et al. 2021

Biology

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Aims: Myocardial abnormalities are common during COVID-19 infection and recovery. We examined left (LV) and right (RV) ventricular longitudinal strain in patients who had recovered from COVID-19 and assessed the correlation with exercise capacity. Methods and results: One hundred and eighty-four consecutive patients with history of COVID-19 disease who had been referred to rest or stress echocardiography because of symptoms, mainly dyspnea and chest pain, were included in the study. These patients were compared to 106 patients with similar age, symptoms, and risk factor profile with no history of COVID-19 disease. Clinical and echocardiographic parameters, including strain imaging, were assessed. The patient’s age was 48 ± 12 years. Twenty-two patients had undergone severe disease. There were no differences in the LV ejection fraction and diastolic function between the groups. However, LV and RV global and free wall strain were significantly lower (in absolute numbers) in patients who had recovered form COVID-19 infection (−20.41 ± 2.32 vs −19.39 ± 3.36, p = 0.001, −23.69 ± 3.44 vs −22.09 ± 4.20, p = 0.001 and −27.24 ± 4.7 vs −25.43 ± 4.93, p = 0.021, respectively). Global Longitudinal Strain (GLS) < −20% was present in only 37% of post COVID-19 patients. Sixty-four patients performed exercise echocardiography. Patients with GLS < −20% had higher exercise capacity with higher peak metabolic equivalent and exercise time compared to patients with GLS ≥ −20% (12.6 ± 2 vs 10 ± 2.5 METss and 8:00 ± 2:08 vs 6:24 ± 2:03 min, p < 0.001 and p = 0.003, respectively). Conclusion: In patients, who had recovered from COVID-19 infection, both LV and RV strain are significantly lower compared to control patients. The exercise capacity of these patients correlates with LV strain values. Rest and stress echocardiography in patients with symptoms after COVID-19 infection may identify patients that need further follow up to avoid long term complications of the disease. These preliminary results warrant further research, to test the natural history of these findings and the need and timing of treatment.

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Recovery of cardiac function following COVID‐19 – ECHOVID‐19: a prospective longitudinal cohort study

Abstract: The degree of cardiovascular sequelae following COVID-19 remains unknown. The aim of this study was to investigate whether cardiac function recovers following COVID-19.

Cited by 49 publications

References 27 publications

Association of chronic heart failure with mortality in old intensive care patients suffering from Covid‐19

Association of chronic heart failure with mortality in old intensive care patients suffering from Covid‐19

Long-term cardio-vascular risk assessment in chronic kidney disease and kidney transplanted patients following SARS-COV-2 disease: protocol for multi-center observational match controlled trial

Subclinical Myocardial Dysfunction in Patients Recovered from COVID-19 Disease: Correlation with Exercise Capacity

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