Impaired left ventricular deformation and ventricular-arterial coupling in post-COVID-19: association with autonomic dysregulation

Abstract

Coronavirus disease-19 (COVID-19) has extended implications namely the long COVID-19 syndrome. We assessed over-time changes in left ventricular (LV) function, aortic stiffness, autonomic function, and ventricular-arterial coupling (VAC) in post-COVID-19 patients. We followed 34 post-COVID-19 subjects, up to 6 months post-hospital discharge. Subjects without COVID-19 served as control. We evaluated LV global longitudinal strain (LV-GLS), arterial stiffness [carotid-femoral pulse wave velocity (cf-PWV)], and heart rate variability -standard deviation of normal RR intervals (SDNN). VAC was estimated as the ratio of cf-PWV to LV-GLS. Post-COVID-19 individuals (1-month post-hospital discharge) presented with impaired LV-GLS [−18.4%(3.1) vs. −22.0%(2.7), P < 0.001], cf-PWV [12.1 m/s (3.2) vs. 9.6 m/s (1.9), P < 0.001], SDNN [111.3 ms (22.6) vs. 147.2 ms (14.0), P < 0.001], and VAC [−0.68 (0.22) vs. −0.44 (0.10), P < 0.001] compared to control. LV-GLS, SDNN, and VAC improved at the 6-month follow-up however they did not reach control levels. In post-COVID-19 subjects, SDNN and VAC were correlated at the 1-month ( R = 0.499, P = 0.003) and 6-month ( R = 0.372, P = 0.04) follow-up. Long COVID-19 syndrome was associated with impaired LV-GLS, SDNN, and VAC. Post-COVID-19 subjects presented with autonomic dysregulation associated with aortic stiffness, ventricular-arterial impairment, and LV dysfunction, even 6-months post-hospital discharge. These abnormalities may be related to the presence of long COVID-19 syndrome. Graphical abstract

Cardiac function in relation to functional status and fatigue in patients with post-COVID syndrome

“…Speckle tracking deformation abnormalities, especially reduced GLS are highly prevalent in the acute phase of the infection 56,57 . Lower GLS are also evident in PCS patients compared to healthy controls 58 . As an additional observation, our study shows an association between GLS and obesity, higher age and high functional impairment.…”

The Role of Rehabilitation in Arterial Function Properties of Convalescent COVID-19 Patients

“…We have previously reported that patients with long COVID-19 present impaired endothelium-dependent vasodilation compared to their counterparts without long-COVID-19 [ 9 , 37 ]. Endothelium-dependent vasodilation and impaired ventriculoarterial coupling [ 2 ] may contribute to the functional limitations of post-COVID-19, including multisystem deconditioning and subsequent exercise intolerance and muscle weakness [ 38 , 39 ].…”

“…The interaction between coronavirus disease (COVID-19) and the cardiovascular system is multifaceted and well documented, extending from direct or inflammatory injury to the myocardium to endothelial involvement and impairment [ 1 , 2 , 3 ]. Furthermore, microvascular dysfunction, atherosclerotic plaque progression and vulnerability as well as accelerated arteriosclerosis have been reported [ 2 , 4 ].…”

“…The interaction between coronavirus disease (COVID-19) and the cardiovascular system is multifaceted and well documented, extending from direct or inflammatory injury to the myocardium to endothelial involvement and impairment [ 1 , 2 , 3 ]. Furthermore, microvascular dysfunction, atherosclerotic plaque progression and vulnerability as well as accelerated arteriosclerosis have been reported [ 2 , 4 ]. Several mechanisms have been implicated in this interplay between COVID-19 and arterial health, including the COVID-19-related inflammatory cascade, the interaction between the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spike protein and angiotensin-converting enzyme 2 (ACE2), and the subsequently increased activity of angiotensin (Ang) II/Ang II receptor type 1 (AT1) [ 1 , 5 , 6 ].…”

“…Importantly, the effects of COVID-19 may extend beyond the acute phase of the disease with symptoms involving multiple organs or systems, and this situation describes post-COVID-19 syndrome [ 2 , 7 , 8 ]. Vascular function and atherosclerosis data show that up to 6 months post-acute COVID-19, subjects continue to present impairment of vascular function parameters, which may be implicated in a situation of accelerated atherosclerosis [ 9 ].…”