Subclinical Left Ventricular Systolic Dysfunction Detected by 2D Speckle-Tracking in Young Adults Post–COVID-19 Recovery

Document Type : Original Article

Authors

Cardiovascular Medicine Department, Tanta Faculty of Medicine, Egypt.

Abstract

Background: Coronavirus disease 2019 (COVID-19) was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.  Apart from respiratory findings, cardiac involvement has been highlighted by some studies. COVID-19 is increasing rapidly among young adults. The present study was designed to evaluate left ventricular function using speckle-tracking echocardiography in young adult COVID-19 patients who underwent home recovery.
Methods: The study assessed 40 patients aged between 18 and 39 years who recovered at home from COVID-19 and 20 healthy control subjects. All the participants underwent evaluations of left and right ventricular function via the conventional and global longitudinal strain (GLS) technique measured by speckle-tracking echocardiography.
Results: Heart rate was significantly higher in the post–COVID-19 group (P=0.024). The patients were assessed for a mean period of 38.8 days (standard deviation=10.9 d) after negative COVID-19 testing. In the post–COVID-19 group, 19 patients (47%) reported ongoing dyspnea: 13 had dyspnea during ordinary daily activities and 6 had dyspnea during less-than-ordinary daily activities. Nine patients (23%) had chest pain, 8 (20%) had palpitations, 22 (55%) had fatigue, and 4 (10%) had joint pain. The left ventricular GLS value for the post–COVID-19 group was significantly impaired compared with the control group (P=0.006).
Conclusions: Among our young adult patients, who had recovered from COVID-19 at home, left ventricular GLS was affected, which may indicate the subclinical impairment of left ventricular systolic function. (Iranian Heart Journal 2022; 23(2): 106-115)

Keywords

References

  1. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5:811–8. https://doi.org/10.1001/jamacardio.2020.1017.
  2. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020; 5:802–10. https://doi.org/10.1001/jamacardio.2020.0950.
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395:497–506. https://doi.org/10.1016/S0140-6736(20)30183-5.
  4. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395:1417–8. https://doi.org/10.1016/S0140-6736(20)30937-5.
  5. Yang J, Biery DW, Singh A, Divakaran S, DeFilippis EM, Wu WY, et al. Risk Factors and Outcomes of Very Young Adults Who Experience Myocardial Infarction: The Partners YOUNG-MI Registry. Am J Med 2020; 133:605-612.e1. https://doi.org/10.1016/j.amjmed.2019.10.020.
  6. Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020; 69:993–8. https://doi.org/10.15585/mmwr.mm6930e1.
  7. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA - J Am Med Assoc 2020; 324:603–5. https://doi.org/10.1001/jama.2020.12603.
  8. Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J 2020; 41:3038–44. https://doi.org/10.1093/eurheartj/ehaa623.
  9. Tops LF, Delgado V, Marsan NA, Bax JJ. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail 2017; 19:307–13. https://doi.org/10.1002/ejhf.694.
  10. Lang RM, Badano LP, Victor MA, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003.
  11. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. J Am Soc Echocardiogr 2009; 22:107–33. https://doi.org/10.1016/j.echo.2008.11.023.
  12. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and . J Am Soc Echocardiogr 2010; 23:685–713. https://doi.org/10.1016/j.echo.2010.05.010.
  13. Parasuraman S, Walker S, Loudon BL, Gollop ND, Wilson AM, Lowery C, et al. Assessment of pulmonary artery pressure by echocardiography-A comprehensive review. IJC Hear Vasc 2016; 12:45–51. https://doi.org/10.1016/j.ijcha.2016.05.011.
  14. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2015;16:1–11. https://doi.org/10.1093/ehjci/jeu184.
  15. Pan F, Ye T, Sun P, Gui S, Liang B, Li L. Time Course of Lung Changes at Chest CT during Recovery. Radiology 2020; 295:715–21.
  16. Dweck MR, Bularga A, Hahn RT, Bing R, Lee KK, Chapman AR, et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging 2020; 21:949–58. https://doi.org/10.1093/ehjci/jeaa178.
  17. Rosen BD, Saad MF, Shea S, Nasir K, Edvardsen T, Burke G, et al. Hypertension and smoking are associated with reduced regional left ventricular function in asymptomatic individuals: The Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol 2006; 47:1150–8. https://doi.org/10.1016/j.jacc.2005.08.078.
  18. Choi J-O, Cho SW, Song YB, Cho SJ, Song BG, Lee S-C, et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. Eur J Echocardiogr 2009;10:695–701. https://doi.org/10.1093/ejechocard/jep041.
  19. Fonseca CG, Dissanayake AM, Doughty RN, Whalley GA, Gamble GD, Cowan BR, et al. Three-dimensional assessment of left ventricular systolic strain in patients with type 2 diabetes mellitus, diastolic dysfunction, and normal ejection fraction. Am J Cardiol 2004; 94:1391–5. https://doi.org/10.1016/j.amjcard.2004.07.143.
  20. Kang SJ, Lim HS, Choi BJ, Choi SY, Hwang GS, Yoon MH, et al. Longitudinal Strain and Torsion Assessed by Two-Dimensional Speckle Tracking Correlate with the Serum Level of Tissue Inhibitor of Matrix Metalloproteinase-1, a Marker of Myocardial Fibrosis, in Patients with Hypertension. J Am Soc Echocardiogr 2008; 21:907–11. https://doi.org/10.1016/j.echo.2008.01.015.
  21. Wasilewski PG, Mruk B, Mazur S, Półtorak-Szymczak G, Sklinda K, Walecki J. COVID-19 severity scoring systems in radiological imaging – A review. Polish J Radiol 2020; 85:e361–8. https://doi.org/10.5114/pjr.2020.98009.
  22. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. J Card Fail 2020; 26:470–5. https://doi.org/10.1016/j.cardfail.2020.04.009.
  23. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020; 81:e16–25. https://doi.org/10.1016/j.jinf.2020.04.021.
  24. Baycan OF, Barman HA, Atici A, Tatlisu A, Bolen F, Ergen P, et al. Evaluation of biventricular function in patients with COVID-19 using speckle tracking echocardiography. Int J Cardiovasc Imaging 2020. https://doi.org/10.1007/s10554-020-01968-5.
  25. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered from Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5:1265–73. https://doi.org/10.1001/jamacardio.2020.3557.
  26. Kotecha T, Knight DS, Razvi Y, Kumar K, Vimalesvaran K, Thornton G, et al. Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance. Eur Heart J 2021; 42:1866–78. https://doi.org/10.1093/eurheartj/ehab075.
  27. Knight DS, Kotecha T, Razvi Y, Chacko L, Brown JT, Jeetley PS, et al. COVID-19: Myocardial injury in survivors. Circulation 2020:1120–2. https://doi.org/10.1161/CIRCULATIONAHA.120.049252.
  28. Huang L, Zhao P, Tang D, Zhu T, Han R, Zhan C, et al. Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2020; 13:2330–9. https://doi.org/10.1016/j.jcmg.2020.05.004.
  29. Brito D, Meester S, Yanamala N, Patel HB, Balcik BJ, Casaclang-Verzosa G, et al. High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19. JACC Cardiovasc Imaging 2020. https://doi.org/10.1016/j.jcmg.2020.10.023.
  30. Bao C, Liu X, Zhang H, Li Y, Liu J. Coronavirus Disease 2019 (COVID-19) CT Findings: A Systematic Review and Meta-analysis. J Am Coll Radiol 2020; 17:701–9. https://doi.org/10.1016/j.jacr.2020.03.006.
  31. Fox K, Prokup JA, Butson K, Jordan K. Acute Effusive Pericarditis: A Late Complication of COVID-19. Cureus 2020; 12:8–13. https://doi.org/10.7759/cureus.9074.
  32. Derveni V, Kaniaris E, Toumpanakis D, Potamianou E, Ioannidou I, Theodoulou D, et al. Acute life-threatening cardiac tamponade in a mechanically ventilated patient with COVID-19 pneumonia. IDCases 2020; 21:e00898. https://doi.org/10.1016/j.idcr.2020.e00898.
Iranian Heart Journal
Volume 23, Issue 2
April 2022
Pages 106-115

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