Impairment of right ventricular longitudinal strain associated with severity of pneumonia in patients recovered from COVID-19

Abstract

Myocardial injury caused by COVID-19 was reported in hospitalized patients previously. But the information about cardiac consequences of COVID-19 after recovery is limited. The aim of the study was comprehensive echocardiography assessment of right ventricular (RV) in patients recovered from COVID-19. This is a prospective, single-center study. After recovery from COVID-19, echocardiography was performed in consecutive 79 patients that attended follow-up visits from July 15 to November 30, 2020. According to the recovery at home vs hospital, patients were divided into two groups: home recovery (n = 43) and hospital recovery (n = 36). Comparisons were made with age, sex and risk factor-matched control group (n = 41). In addition to conventional echocardiography parameters, RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS) were determined using 2D speckle-tracking echocardiography (2D STE). Of the 79 patients recovered from COVID-19, 43 (55%) recovered at home, while 36 (45%) required hospitalization. The median follow-up duration was 133 ± 35 (87–184) days. In patients recovered from hospital, RV-GLS and RV-FWS were impaired compared to control group (RV-GLS: −17.3 ± 6.8 vs. −20.4 ± 4.9, respectively [p = 0.042]; RV-FWS: −19.0 ± 8.2 vs. −23.4 ± 6.2, respectively [p = 0.022]). In subgroup analysis, RV-FWS was impaired in patients severe pneumonia (n = 11) compared to mild-moderate pneumonia (n = 28), without pneumonia (n = 40) and control groups (−15.8 ± 7.6 vs. −21.6 ± 7.6 vs. −20.8 ± 7.7 vs. −23.4 ± 6.2, respectively, [p = 0.001 for each]) and RV-GLS was impaired compared to control group (−15.2 ± 6.9 vs. −20.4 ± 4; respectively, [p = 0.013]). A significant correlation was detected between serum CRP level at hospital admission and both RV-GLS and RV-FWS (r = 0.285, p = 0.006; r = 0.294, p = 0.004, respectively). Age (OR 0.948, p = 0.010), male gender (OR 0.289, p = 0.009), pneumonia on CT (OR 0.019, p = 0.004), and need of steroid in treatment (OR 17.424, p = 0.038) were identifed as independent predictors of impaired RV-FWS (> −18) via multivariate analysis. We demonstrated subclinic dysfunction of RV by 2D-STE in hospitalized patients in relation to the severity of pneumonia after recovery from COVID-19. 2D-STE supplies additional information above standard measures of RV in this cohort and can be used in the follow-up of these patients.

Echocardiographic assessment of the right ventricle in COVID-19: a systematic review

“…A case-control study with 51 patients with COVID-19 patients recovering from the acute illness without need of IMV reported higher RVEDA compared to controls at one month from hospital discharge [39]. Similar results were obtained in another study with follow up at a median time of 133 ± 35 days [52].…”

“…This prevalence of PH is higher compared to the general population [78]. Other studies found elevated sPAP and PH as a common COVID-19 complication [39,52], highlighting the need to further investigate long-term sequalae involving the RV after SARS-CoV-2 infection.…”

Cardiovascular Imaging Evaluation in COVID-19 Heart and Vascular Non-Ischaemic Involvement

“…Patients with cardiac injury were characterized by decreased strain of both LV and RV. These results were correlated with higher biomarkers levels of inflammation and cardiac injury, and the presence of pericardial effusion [165,166]. Moreover, patients who died were afflicted by impaired LS, an independent predictor of mortality in a Cox analysis.…”

Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19

“…Heart involved patients were characterized by decreased of both LV and RV strain. These results were correlated with higher biomarkers of cardiac injury and inflammation as well as by the presence of pericardial effusion [ 165 , 166 ]. Moreover, patients who died were afflicted by impaired LS, an independent predictor of mortality in a Cox analysis.…”

“…Therefore, at 3-month follow-up visit after discharge in survivors, a significant improvement was observed in both right and left LS [ 165 ]. However, RVLS worsened in patients who experienced hospitalization due to their clinical conditions, especially if they had severe pneumonia [ 166 ].…”