Subclinical left and right ventricular dysfunction in COVID-19 recovered patients using speckle tracking echocardiography

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction Myocardial injury during acute COVID-19 infection is well characterised however, its persistence during recovery is unclear. Purpose We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricular (RV) free wall longitudinal strain and RV global longitudinal strain (RV-GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients (30-45 days post recovery) and studied its correlation with various parameters. Methods Of the 245 subjects screened, a total of 53 subjects recovered from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results All the 53 subjects were symptomatic during COVID-19 illness and were categorized as mild: 27 (50.9%), moderate: 20 (37.7%) and severe: 6 (11.4%) COVID-19 illness. Reduced LV GLS was reported in 22 (41.5%), reduced RV-GLS in 23 (43.4%) and reduced RVFWS in 22 (41.5%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -20.3 ± 1.7%; moderate: -15.3 ± 3.4%; severe: -10.7 ± 5.1%; P < 0.0001). Similarly, RVGLS (mild: -21.8 ± 2.8%; moderate: -16.8 ± 4.8%; severe: -9.7 ± 4.6%; P < 0.0001) and RVFWS (mild: -23.0 ± 4.1%; moderate: -18.1 ± 5.5%; severe: -9.3 ± 4.4%; P < 0.0001) were significantly lower in subjects with severe COVID-19. Subjects with reduced LVGLS as well as RVGLS and RVFWS had significantly higher interleukin-6, C-reactive protein, lactate dehydrogenase and serum ferritin levels during index admission. Conclusions Subclinical LV and RV dysfunction was seen in majority of COVID-19 recovered patients. Patients with severe disease during index admission had far lower LV and RVGLS as compared to mild and moderate cases. Our study highlights the need for close follow-up of COVID-19 recovered subjects in order to determine the long-term cardiovascular outcomes.