Background

COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection.

Methods

Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyzable, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardiographic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function.

Results

For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not significantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a significant reduction of LVEF at follow-up (74.3% ± 3.1% vs 64.4% ± 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% ± 5.9% vs 49.3% ± 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<−18%) at baseline had a significant reduction of LVLS at follow-up (−21.6% ± 2.6% vs −20.3% ± 4.0%, P = .006), while patients with impaired LVLS at baseline had a significant improvement at follow-up (−14.5% ± 2.9% vs −16.7% ± 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>−20%) at baseline had significant improvement at follow-up (−15.2% ± 3.4% vs −17.4% ± 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 ± 0.7 cm vs 4.6 ± 0.6 cm, P = .019).

Conclusions

Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.

中文翻译：

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急性 COVID-19 感染患者的心室变化：世界超声心动图联盟 (WASE-COVID) 研究的随访

背景

已知 COVID-19 感染会导致广泛的临床慢性后遗症，但对长期心脏并发症知之甚少。我们的目标是报告超声心动图随访结果并描述急性感染后左心室 (LV) 和右心室 (RV) 功能的变化。

方法

参加世界超声心动图协会-COVID 研究的急性 COVID-19 感染患者被要求返回进行后续经胸超声心动图检查。总体而言，198 人在平均 129 天的随访中返回，其中 153 人具有可分析的配对基线和随访图像，包括 LV 容积、射血分数 (LVEF) 和纵向应变 (LVLS)。右侧超声心动图参数包括 RV 整体纵向应变、RV 游离壁应变和 RV 基底直径。根据基线 LV 和 RV 功能比较了整个队列和亚组在基线和随访时的配对超声心动图参数。

结果

对于整个队列，随访时 LV 和 RV 功能的超声心动图标志物与基线没有显着差异（所有P  > .05）。基线时 LVEF 高动态 (>70%) 的患者在随访时 LVEF 显着降低 (74.3% ± 3.1% vs 64.4% ± 8.1%, P  < .001)，而基线时 LVEF 降低的患者 (< 50%) 有显着增加（42.5% ± 5.9% vs 49.3% ± 13.4%，P  = .02），LVEF 正常者没有变化。基线时 LVLS 正常 (<-18%) 的患者在随访时 LVLS 显着降低 (-21.6% ± 2.6% vs -20.3% ± 4.0%, P  = .006)，而基线时 LVLS 受损的患者随访中有显着改善（-14.5% ± 2.9% vs -16.7% ± 5.2%，P < .001)。基线时存在异常 RV 整体纵向应变 (>-20%) 的患者在随访时有显着改善（-15.2% ± 3.4% vs -17.4% ± 4.9%，P  = .004）。基线时 RV 基底直径异常 (>4.5 cm) 的患者在随访时有显着改善 (4.9 ± 0.7 cm vs 4.6 ± 0.6 cm, P  = .019)。

结论

总体而言，随着时间的推移，从 COVID-19 感染中恢复的患者的左室和右室功能没有显着变化。然而，根据基线 LV 和 RV 功能观察到差异，这可能反映了从急性病中发生的急性心肌损伤中的恢复。左心室和右室功能在基线功能受损的患者中趋于改善，而在左室动力过强或右室功能正常的患者中趋于下降。