Evolution of right and left ventricle routine and speckle-tracking echocardiography in patients recovering from coronavirus disease 2019: a longitudinal study

Baruch, Guy; Rothschild, Ehud; Sadon, Sapir; Szekely, Yishay; Lichter, Yael; Kaplan, Alon; Taieb, Philippe; Banai, Ariel; Hochstadt, Aviram; Merdler, Ilan; Arbel, Yaron; Laufer‐Perl, Michal; Beer, Gil; Kapusta, Livia

doi:10.1093/ehjci/jeab190

Cited by 21 publications

(37 citation statements)

References 37 publications

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“…Nevertheless, it is important to note that the reduction in LV functional parameters rarely reached the abnormal range. Because this study, and the recent study published by Baruch et al ., 12 showing a similar prevalence of 25% abnormal LV STE, were done on consecutive hospitalized patients, with all grades of clinical disease, they probably represent a more accurate picture of the level of persisting cardiac pathology in survivors of patients hospitalized for COVID‐19 compared to preliminary reports. 6 , 9 Another important advantage of the present study was the routine use of STE.…”

Section: Left Ventricular Function Post‐ Covid‐ 19mentioning

confidence: 69%

“…Similar results were presented in another recent prospective longitudinal study by Baruch et al . 12 In that study, non‐invasive haemodynamic evaluation was performed concomitantly with routine and STE and showed that during the acute phase of COVID‐19 infection RV remodelling or dysfunction are associated with elevated pulmonary vascular resistance. 4 , 12 Proposed mechanisms included either pulmonary embolism, hypoxic pulmonary vasoconstriction, elevated left atrial pressure, or combination of the above.…”

Section: Right Ventricular Function Post‐ Covid‐ 19mentioning

confidence: 99%

“… 12 In that study, non‐invasive haemodynamic evaluation was performed concomitantly with routine and STE and showed that during the acute phase of COVID‐19 infection RV remodelling or dysfunction are associated with elevated pulmonary vascular resistance. 4 , 12 Proposed mechanisms included either pulmonary embolism, hypoxic pulmonary vasoconstriction, elevated left atrial pressure, or combination of the above. The authors postulated that the increase in RV afterload during acute infection may decrease RV function, and may even decrease RV contractility by a reduction in coronary perfusion, or septal bowing towards the left ventricle.…”

Section: Right Ventricular Function Post‐ Covid‐ 19mentioning

confidence: 99%

“…All things considered, it is important to note that similar results, concerning persistence of subtle LV dysfunction in almost a quarter of hospitalized patients months post‐acute COVID‐19 infection, were observed by other research groups as well. 9 , 12 The sample size was relatively small, and not all participants agreed to participate in the follow‐up examination creating significant bias. Even more important, although the study included patients with milder forms of acute disease, it included only hospitalized patients.…”

Section: Limitations Clinical Implications and Future Perspectivesmentioning

confidence: 99%

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Recovery of cardiac function following COVID‐19

Ghantous

Topilsky

2021

European J of Heart Fail

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This article refers to 'Recovery of cardiac function following COVID-19 -ECHOVID-19: a prospective longitudinal cohort study' by M.C.H. Lassen et al., published in this issue on pages 1903-1912.There has been a large number of publications concerning cardiac complications in acute coronavirus disease 2019 (COVID-19) infection. [1][2][3][4][5] Myocardial injury during the acute phase of COVID-19 raises the question of potential long-term cardiac implications, however, less is known about these potential consequences. Preliminary magnetic resonance imaging (MRI) based reports described common persistence of subtle cardiac injury in recovered patients. 6,7 However, these studies used extremely sensitive MRI protocols and lacked baseline imaging and comparison to control healthy patients. In an early echocardiographic study on survivors of COVID-19 infection, even patients with prior detection of increased troponin did not have any evidence of persistent cardiac dysfunction. 8 However, the study included mostly patients at low risk for persistent cardiac injury, and lacked baseline imaging obtained during hospitalization. Furthermore, speckle tracking echocardiography (STE), that would detect more subtle cardiac changes, was not performed.The first longitudinal echocardiographic study (including both baseline and follow-up echo exams) analysing the persistence of cardiac pathology following COVID-19 infection had different results. 9 Forty-one percent of patients had right ventricular (RV) remodelling or dysfunction during acute infection, but only ≈15% had either left ventricular (LV) alone, or biventricular involvement. At 3 months post-acute infection, there was reverse RV remodelling in the majority of patients with abnormal right ventricle at baseline, but no significant changes in LV parameters. However, the study was subjected to selection bias because baseline echo during hospitalization was performed only in patients with critical disease, or clinical deterioration.In this issue of the Journal, Lassen et al. 10 used the ECHOVID-19 cohort, which is a large multicentre prospective cohort, including unselected patients with COVID-19 that underwent an echo The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Section: Left Ventricular Function Post‐ Covid‐ 19mentioning

confidence: 69%

Section: Right Ventricular Function Post‐ Covid‐ 19mentioning

confidence: 99%

Section: Right Ventricular Function Post‐ Covid‐ 19mentioning

confidence: 99%

Section: Limitations Clinical Implications and Future Perspectivesmentioning

confidence: 99%

See 2 more Smart Citations

Recovery of cardiac function following COVID‐19

Ghantous

Topilsky

2021

European J of Heart Fail

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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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Abnormal echocardiographic findings after COVID-19 infection: a multicenter registry

Picco¹,

Lépori

Galello³

et al. 2022

Int J Cardiovasc Imaging

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The Coronavirus Disease 2019 (COVID-19) pandemic has transformed health systems worldwide. There is conflicting data regarding the degree of cardiovascular involvement following infection. A registry was designed to evaluate the prevalence of echocardiographic abnormalities in adults recovered from COVID-19. We prospectively evaluated 595 participants (mean age 45.5 ± 14.9 years; 50.8% female) from 10 institutions in Argentina and Brazil. Median time between infection and evaluation was two months, and 82.5% of participants were not hospitalized for their infection. Echocardiographic studies were conducted with General Electric equipment; 2DE imaging and global longitudinal strain (GLS) of both ventricles were performed. A total of 61.7% of the participants denied relevant cardiovascular history and 41.8% had prolonged symptoms after resolution of COVID-19 infection. Mean left ventricular ejection fraction (LVEF) was 61.0 ± 5.5% overall. In patients without prior comorbidities, 8.2% had some echocardiographic abnormality: 5.7% had reduced GLS, 3.0% had a LVEF below normal range, and 1.1% had wall motion abnormalities. The right ventricle (RV) was dilated in 1.6% of participants, 3.1% had a reduced GLS, and 0.27% had reduced RV function. Mild pericardial effusion was observed in 0.82% of participants. Male patients were more likely to have new echocardiographic abnormalities (OR 2.82, p = 0.002). Time elapsed since infection resolution (p = 0.245), presence of symptoms (p = 0.927), or history of hospitalization during infection (p = 0.671) did not have any correlation with echocardiographic abnormalities. Cardiovascular abnormalities after COVID-19 infection are rare and usually mild, especially following mild infection, being a low GLS of left and right ventricle, the most common ones in our registry. Post COVID cardiac abnormalities may be more frequent among males. Supplementary Information The online version contains supplementary material available at 10.1007/s10554-022-02706-9.

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Evolution of right and left ventricle routine and speckle-tracking echocardiography in patients recovering from coronavirus disease 2019: a longitudinal study

Cited by 21 publications

References 37 publications

Recovery of cardiac function following COVID‐19

Recovery of cardiac function following COVID‐19

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

Abnormal echocardiographic findings after COVID-19 infection: a multicenter registry

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