Cardiac imaging phenotype in patients with coronavirus disease 2019 (COVID-19): results of the cocarde study

Abstract

Biological cardiac injury related to the Severe Acute Respiratory Syndrome Coronavirus-2 infection has been associated with excess mortality. However, its functional impact remains unknown. The aim of our study was to explore the impact of biological cardiac injury on myocardial functions in patients with COVID-19. 31 patients with confirmed COVID-19 (CoV+) and 16 controls (CoV−) were prospectively included in this observational study. Demographic data, laboratory findings, comorbidities, treatments and myocardial function assessed by transthoracic echocardiography were collected and analysed in CoV+ with (TnT+) and without (TnT−) elevation of troponin T levels and compared with CoV−. Among CoV+, 13 (42%) exhibited myocardial injury. CoV+/TnT + patients were older, had lower diastolic arterial pressure and were more likely to have hypertension and chronic renal failure compared with CoV+/TnT−. The control group was comparable except for an absence of biological inflammatory syndrome. Left ventricular ejection fraction and global longitudinal strain were not different among the three groups. There was a trend of decreased myocardial work and increased peak systolic tricuspid annular velocity between the CoV− and CoV + patients, which became significant when comparing CoV− and CoV+/TnT+ (2167 ± 359 vs. 1774 ± 521%/mmHg, P = 0.047 and 14 ± 3 vs. 16 ± 3 cm/s, P = 0.037, respectively). There was a decrease of global work efficiency from CoV− (96 ± 2%) to CoV+/TnT− (94 ± 4%) and then CoV+/TnT+ (93 ± 3%, P = 0.042). In conclusion, biological myocardial injury in COVID 19 has low functional impact on left ventricular systolic function. Keywords COVID-19 • SARS-CoV-2 • Speckle tracking echocardiography • Strain • Myocardial work. Abbreviations CT Computed tomography hs-TnT High-sensitivity troponin T IQR Interquartile ranges LS Longitudinal strain TTE Transthoracic echocardiography RT-PCR Real-time reverse transcriptase-polymerase chain reaction SARS-CoV-2 Severe acute respiratory syndrome coronavirus-2 TAPSE Tricuspid annular plane systolic excursion

COVID-19-related echocardiographic patterns of cardiovascular dysfunction in critically ill patients: A systematic review of the current literature

“…Overall, the studies included a median of 52.0% (0.0–100.0) of patients admitted to ICU, undergoing forms of invasive or non-invasive mechanical ventilation in 57.0% (34.0–81.0) and 13.0% (8.6–32.7) of cases, respectively. Ten studies (32.2%) were retrospective [ 17 , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ], and 20 (66.6%) monocentric [ 15 , 17 , 18 , [20] , [21] , [22] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ].…”

“…Seven studies (24.1%) [ 16 , 18 , 24 , [29] , [30] , [31] , 35 ] reported an advanced assessment of either LV GLS. Among the 49 subjects included in the study of Bursi et al, non-survivors (33%) showed a significantly lower LV GLS [ 24 ].…”

Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

“…However, a study showed that elevated troponin was not associated with LV-GLS in patients with COVID-19, despite an increase in adverse events [26]. A smaller study showed that there was no significant difference in terms of LV-GLS between those without COVID-19, with COVID-19, and COVID-19 + increased cardiac troponin [27]. Thus, reduced GLS might also be affected by acute conditions such as myopericardial damage and acute respiratory distress syndrome to other chronic causes (comorbidities) such as cardiovascular diseases, hypertension, and diabetes.…”

The role of pre-existing chronic disease in cardiac complications from SARS-CoV-2 infection: A systematic review and meta-analysis

“…20 studies measured cardiac outcomes on the day of admission [3,29,32,34,35,37–41,43–48,50-52,57], and one at the time of patient death [33], with the remaining eight studies not specifying the time of assessment [4,36,42,49,53–55]. The studies were conducted in 10 countries in four geographical locations (U.S.A. [32,33,41,48,49], the Middle East [34,50,52], Europe [4,35–40,44,45,47], and the People’s Republic of China [3,29,42,43,46,51,53–57]) with a total of 3553 COVID-19 patients developing cardiac complications and 13,225 COVID-19 patients without cardiac complications. Patients who presented with SARS-CoV-2 associated cardiac complications were, on average, 10 years older than in those who did not (Table 2).…”

“…As large heterogeneity was detected amongst the total combined study cohort, the cohort was subdivided based on general global region in an attempt to account for this. Cohorts were divided into studies with cohorts primarily situated in the U.S.A [32,33,41,48,49], the Middle East [34,50,52], Europe [4,35–40,44,45,47], and China [3,29,42,43,46,51,53–57].…”