Long-Term Cardiac Sequelae in Patients Referred into a Diagnostic Post-COVID-19 Pathway: The Different Impacts on the Right and Left Ventricles

Pelà, Giovanna; Goldoni, Matteo; Cavalli, Chiara; Perrino, Felice; Tagliaferri, Sara; Frizzelli, Annalisa; Mori, Pier Anselmo; Majori, Maria; Aiello, Marina; Sverzellati, Nicola; Corradi, Massimo; Chetta, Alfredo

doi:10.3390/diagnostics11112059

Cited by 18 publications

(15 citation statements)

References 30 publications

(57 reference statements)

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“…Demographics, co-morbidities, and acute organ dysfunction at admission were correlated with lower LVEF and higher BNP. Other studies found ventricular systolic dysfunction in Post-COVID-19 condition (23,24,31) and acute cardiac dysfunction was associated with readmission and late mortality (57). Surprisingly, we did not observe any associations of acute hospital course variables with subjective 3and 6-month outcomes (quality of life, shortness of breath or frailty).…”

Section: Discussioncontrasting

confidence: 92%

“…Prior studies show features of restrictive lung disease in Post-COVID-19 condition: decreased diffusing capacity (25) in 45 to 50% (16,17,25) and decreased lung volumes (26)(27)(28)(29). Objective cardiac dysfunction in Post-COVID-19 condition is less common: increased pulmonary artery pressures, left ventricular strain (30), and ventricular systolic dysfunction in 10(31)-15% (13,23,24,31). Renal dysfunction occurs in Post-COVID-19 condition (32,33).…”

Section: Introductionmentioning

confidence: 99%

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Hospital Admission and Hospital Course Predictors of Severity of Post-covid-19 Condition

Tran

Lee

Levin

et al. 2022

Preprint

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BACKGROUND: Prediction of severity of Post-COVID-19 condition is not clear. We determined whether hospital course variables correlated with objective and subjective outcomes 3- and 6-months post-COVID-19 onset.METHODS: Adults admitted to hospital with acute COVID-19 were recruited (Feb 15, 2020-April 1, 2021) from two tertiary hospitals in Vancouver, Canada. We recorded baseline characteristics, COVID severity score, organ function, ICU and hospital length of stay. Survivors were evaluated at 3- and 6-months post- COVID-19 onset: subjective: University of California San Diego Shortness of Breath Score, EuroQol 5D Visual Analogue Scale, Frailty Index; Objective: functional capacity (6-minute walk test), pulmonary (pulmonary function tests), cardiac (echocardiography, BNP), renal (creatinine), hepatic (AST, ALT, bilirubin), and coagulation (aPTT, INR, D-dimers, fibrinogen). RESULTS: In 133 post-COVID-19 patients (age 62 ± 14 years, 65% male with frequent comorbidities [hypertension (42%), diabetes (29%), chronic cardiac (22%)), 42% were admitted to Intensive Care Unit: 23%, 23% and 2% required ventilation, vasopressors or renal support, respectively. One-third had restrictive lung function (<80% predicted FVC %, TLC%, or DLCO%) at 3 months. Novel findings were correlations of (1) acute hepatic dysfunction with restrictive lung function at 3 months post COVID-19 onset; (2) more severe acute COVID-19 with later pro-thrombotic phenotype and (3) greater acute organ dysfunction with later objective organ dysfunction at 3- and 6-months. No hospital course variables were associated with subjective outcomes at 3- and 6-months. CONCLUSIONS: Early organ dysfunction predicts later objective pathology especially restrictive lung disease and a pro-coagulant state. These hypothesis-generating findings require further validation in additional patients.

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Section: Discussioncontrasting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Hospital Admission and Hospital Course Predictors of Severity of Post-covid-19 Condition

Tran

Lee

Levin

et al. 2022

Preprint

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“…The presence of subclinical RV dysfunction in patients with COVID‐19 is important to discuss as reductions in RV strain are associated with greater mortality (Li et al, 2020 ). RV strain does appear to be a common finding during follow‐ups, even in patients with no history of cardiovascular or lung disease, and no presence of heart failure symptoms (Nuzzi et al, 2021 ), indicating that there is potential for silent cardiac (myocyte) damage and hemodynamic instability post‐COVID‐19 (Pelà et al, 2021 ).…”

Section: Cardiac Functionmentioning

confidence: 99%

Cardiac impairments in postacute COVID ‐19 with sustained symptoms: A review of the literature and proof of concept

Singh

Bhagaloo

et al. 2022

Physiological Reports

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Although acute COVID‐19 is known to cause cardiac damage in some cases, there is still much to learn about the duration and relative permanence of the damage that may occur. Long COVID is a condition that can occur when COVID‐19 symptoms remain in the postviral acute period. Varying accounts of long COVID have been described across the literature, however, cardiac impairments are sustained in many individuals and cardiovascular assessment is now considered to be an expected follow‐up examination. The purpose of this review and proof of concept is to summarize the current research related to the assessment of cardiac function, including echocardiography and blood biomarker data, during the follow‐up period in patients who recovered from COVID‐19. Following a literature review, it was found that right ventricular dysfunction along with global longitudinal strain and diastolic dysfunction are common findings. Finally, more severe acute myocardial injury during the index hospitalization appears to exacerbate cardiac function. The available literature implies that cardiac function must be monitored in patients recovered from COVID‐19 who remain symptomatic and that the impairments and severity vary from person‐to‐person. The proof‐of‐concept analysis of patients with cardiac disease and respiratory disease in comparison to those with sustained symptoms from COVID‐19 suggests elevated systolic time interval in those with sustained symptoms from COVID‐19, thus reducing heart performance indices. Future research must consider the details of cardiac complications during the acute infection period and relate this to the cardiac function in patients with long COVID during mid‐ and long‐term follow‐up.

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“…In patients with persistent symptoms 5 months after initial SARS-CoV2 infection, 39% had echocardiographic findings of RV dilatation, 16% had findings of left ventricular (LV) diastolic dysfunction, and 10% had findings of LV systolic dysfunction [ 58 •]. Another prospective cohort study in low-risk patients with PCS 4 months post-infection found that 9% of patients had some systolic dysfunction on CMR with the incidence increasing as the severity of PCS increased [ 59 •].…”

Section: Heart Failure and Cardiomyopathiesmentioning

confidence: 99%

Cardiac Manifestations of Post-Acute COVID-19 Infection

2022

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Purpose of Review There is emerging evidence that the post-acute and chronic phases of COVID-19 infection are associated with various significant cardiovascular sequelae. Recent Findings Long COVID has been shown to be associated with multiple cardiovascular sequelae including direct myocardial injury, arrhythmias, and cardiomyopathies. Hypotheses on the mechanism of myocardial injury include direct viral infiltration and autoimmune dysregulation. Long COVID is associated with persistent cardiac ischemia in patients with no previous history of coronary disease, atrial and ventricular arrhythmias, and the development of new-onset heart failure in previously healthy patients. Onset of long COVID may be related to severity of the initial SARS-CoV2 infection. Cardiac MRI is a valuable tool in assessing myocarditis and the development of cardiomyopathies in the setting of long COVID. Summary Both patients with and without pre-existing cardiovascular disease are at risk of developing myocardial injury in the setting of long COVID. Future studies will elucidate both cardiovascular mortality and cardiac rehabilitation in the post-acute and chronic phases of COVID-19.

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Long-Term Cardiac Sequelae in Patients Referred into a Diagnostic Post-COVID-19 Pathway: The Different Impacts on the Right and Left Ventricles

Cited by 18 publications

References 30 publications

Hospital Admission and Hospital Course Predictors of Severity of Post-covid-19 Condition

Hospital Admission and Hospital Course Predictors of Severity of Post-covid-19 Condition

Cardiac impairments in postacute COVID ‐19 with sustained symptoms: A review of the literature and proof of concept

Cardiac Manifestations of Post-Acute COVID-19 Infection

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