Cardiovascular involvement in post Covid patients

Authors

  • SORICI Galina Instituția Medico-Sanitară Publică Institutul de Cardiologie Spitalul Polivalent Novamed
  • POPOVICI Ion Instituția Medico-Sanitară Publică Institutul de Cardiologie Spitalul Polivalent Novamed
  • GOROHOVA Marina Instituția Medico-Sanitară Publică Institutul de Cardiologie Spitalul Polivalent Novamed
  • CIOBANU Lucia Instituția Medico-Sanitară Publică Institutul de Cardiologie Spitalul Polivalent Novamed
  • POPOVICI Mihail Instituția Medico-Sanitară Publică Institutul de Cardiologie Spitalul Polivalent Novamed

DOI:

https://doi.org/10.52692/1857-0011.2022.1-72.05

Keywords:

Covid-19, GLS, longCovid

Abstract

Objectives: to highlight the cardiovascular sequelae of Covid-19, especially subclinical dysfunction of the left ventricle. Materials and methods: the study included 74 Covid-19 convalescent patients with no history of cardiovascular disease, with a mean age of 42.01 years ± 1.4 years. Patients were assessed by speckle tracking echocardiography. Results: The results of our study determined that 41 (55.4%) Covid-19 convalescent patients have subclinical left ventricular systolic dysfunction, the mean GLS in the group being 15.8 ± 0.39, while in the control group no person has GLS <16% (p <0.001). Other manifestations were: diastolic dysfunction - 23 (31.1%), right ventricular dysfunction - 22 (30.1%), pericardial effusion - 19 (25.7%), symptoms - 67 (90%). Conclusions: Subclinical cardiac dysfunction is a common complication encountered in convalescent Covid-19 patients, and determination of GLS by speckle tracking echocardiography remains a practical and cost-effective tool to detect this injury; The persistence of symptoms, included in longCovid, does not correlate with the results of imaging investigations.

References

Aagaard EN., Kvisvik B., Pervez Moet al. Ventricular mechanical dispersion in a general population: Data from the Akershus Cardiac Examination 1950 study. Eur Heart J Cardiovasc Imaging. 2020;1;21(2):183-190. doi: 10.1093/ehjci/jez210. PMID: 31504360.

Agarwal A. K., Garg, R., Ritch et al. Postural orthostatic tachycardia syndrome. Postgrad. Med. J. 83, 478–480 (2007).

Akbarshakh A, Marban E. COVID-19 and the heart. Circ Res 2020;126(10):1443–1455;

Ali-Ahmed F, Dalgaard F, Al-Khatib SM. Sudden cardiac death in patients with myocarditis: Evaluation, risk stratification, and management. Am Heart J. 2020;220:2940. doi: 10.1016/j.ahj.2019.08.007.

Arnold C.T. Ng, Matteo Bertini, See Hooi Ewe et al. Defining Subclinical Myocardial Dysfunction and Implications for Patients With Diabetes Mellitus and Preserved Ejection Fraction. The American Journal of Cardiology. 2019; 124(6),892-898. https://doi.org/10.1016/j.amjcard.2019.06.011.

Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I et al. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021;372 :n693

Baratto C, Caravita S, Faini A et al. Impact of COVID-19 on exercise pathophysiology: a combined cardiopulmonary and echocardiographic exercise study. J Appl Physiol. 2021;130(5):1470-1478. doi: 10.1152/japplphysiol.00710.2020.

Bergman E, Loyttyniemi E, Myllyntausta et al. Factors associated with quality of life and work ability among Finnish municipal employees: a cross-sectional study. BMJ Open. 2020;10:e035544.

Betty Ramana, Mark Philip Cassara et al. Global Longitudinal Strain by Echocardiography Predicts LongTerm Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population: The Copenhagen City Heart Study. Circ Cardiovasc Imaging. 2017; 10:3

Bhatia HS, Bui QM, King K, DeMaria A, Daniels LB. Subclinical left ventricular dysfunction in COVID-19. Int J Cardiol Heart Vasc. 2021 Jun;34:100770. doi: 10.1016/j.ijcha.2021.100770. Epub 2021 Mar 24. PMID: 33778152; PMCID: PMC7988446.

Blagova OV, Kogan EA, Lutokhina YA, et al. Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms. Kardiologiia. 2021;61(6):11-27. Russian, English. doi: 10.18087/cardio.2021.6.n1659. PMID: 34311684.

Brage H. Amundsen, Thomas Helle-Valleet al. Noninvasive Myocardial Strain Measurement by Speckle Tracking Echocardiography: Validation Against Sonomicrometry and Tagged Magnetic Resonance Imaging. Journal of the American College of Cardiology. 2006; 47, (4)789-793, ISSN 0735-1097, https://doi.org/10.1016/j.jacc.2005.10.040.

Carvalho-Schneider C, Laurent E, Lemaignen A et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect 2021;27:258e63.

Daugherty S E, Guo Y, Heath K, et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort . BMJ 2021; 373 :n1098 doi:10. 1136/bmj.n1098

Dennis A, Wamil M, Alberts J, et al. Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study. BMJ. 2021;11:e048391.

Desai, A. D., Boursiquot, B. C., Melki, et al. Management of arrhythmias associated with COVID-19. Curr. Cardiol. 2020;23, 2.

Eiros R, Barreiro-Perez M, Martin-Garcia A, et al. Pericarditis and myocarditis long after SARS-CoV-2 infection: a crosssectional descriptive study in health-care workers. medRxiv 2020. Preprint.

Ermakov S, Gulhar R, Lim L, et al Left ventricular mechanical dispersion predicts arrhythmic risk in mitral valve prolapse Heart 2019;105:1063-1069.

Evans A, McAuley H, Ewen et al. Physical, cognitive and mental health impacts of COVID-19 following hospitalisation – a multi-centre prospective cohort study. xiv 2021.03.22.21254057; doi: https://doi.org/10.1101/2021.03.22.21254057

Freaney, P.M.; Shah, S.J.; Khan, S.S. COVID-19 and Heart Failure with Preserved Ejection Fraction. JAMA. 2020, 324, 1499. [CrossRef] [PubMed]

G.D. Aquaro, F. Negri, A. De Luca, et al., Role of right ventricular involvement in acute myocarditis, assessed by cardiac magnetic resonance. Int. J. Cardiol. 2018;271:359–365. H. Shmueli, M. Shah, J.E. Ebinger et al. IJC Heart & Vasculature 32 (2021) 100719 6

Ghosn J, Piroth L, Epaulard O, Le Turnier P, Mentré F, Bachelet D, Laouénan C; French COVID cohort study and investigators groups. Persistent COVID-19 symptoms are highly prevalent 6 months after hospitalization: results from a large prospective cohort. Clin Microbiol Infect. 2021;27(7):1041.e1-1041.e4. doi: 10.1016/j. cmi.2021.03.012. Epub 2021 May 10. PMID: 34125067; PMCID: PMC8107834.

Guan W-J, Ni Z-Y, Hu Y et al (2020). Clinical characteristics of coronavirus disease 2019 in China. New Engl J Med. https ://doi. org/10.1056/NEJMo a2002 032.

Hannah E. Davis, Gina S. Assaf, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact, EClinicalMedicine, Volume 38, 2021,101019, ISSN 2589 5370,https://doi.org/10.1016/j.eclinm.2021.101019)

https://www.nice.org.uk/guidance/ng188).

Huang L, Zhao P, Tang D, et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. JACC Cardiovasc Imag 2020;13:2330e9.

Iqbal A, Iqbal K, Ali SA, et al. The COVID-19 sequelae: a cross-sectional evaluation of post-recovery symptoms and the need for rehabilitation of COVID-19 survivors. Cureus. 2021;13:e13080.

JB Institute. JBI critical appraisal checklist for analytical cross sectional studies 2020. 2021. Available from: https://jbi.global/sites/default/files/2020-08/Checklist_for_Analytical_Cross_Sectional_Studies.pdf.

Jens-Uwe Voigt, Gianni Pedrizzetti. Definitions for a Common Standard for 2D SpeckleTracking Echocardiography: Consensus Document ofthe EACVI/ASE/Industry Task Force to Standardize Deformation Imaging. J Am Soc Echocardiogr 2015;28:183-93./dx.doi.org/10.1016/j. echo.2014.11.003;

Kamal M., Abo Omirah M., Hussein A., Saeed H. Assessment and characterization of post-COVID-19 manifestations. Int J Clin Pract 2020:e13746.

Karim Taha, Mimount Bourfiss, et al. A head-tohead comparison of speckle tracking echocardiography and feature tracking cardiovascular magnetic resonance imaging in right ventricular deformation. European Heart Journal Cardiovascular Imaging, Volume 22, Issue 8, August 2021, Pages 950–958, https://doi.org/10.1093/ehjci/jeaa088

Lassen, M.C.H., Skaarup, K.G., Lind, J.N., Alhakak et al. (2021), Recovery of Cardiac Function Following COVID-19 ECHOVID-19: A Prospective Longitudinal Cohort Study. Eur J Heart Fail. Accepted Author Manuscript. https://doi.org/10.1002/ejhf.2347

Lau D, McAlister FA. Implications of the COVID-19 pandemic for cardiovascular disease and risk factor management. Can J Cardiol 2021;37:722e32.

Lazzerini, P. E., Laghi-Pasini, Fet al. Cardioimmunology of arrhythmias: the role of autoimmune and inflammatory cardiac channelopathies. Nat. Rev. Immunol. 19, 63–64 (2019)

Lindner, D. et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol. 5, 1281–1285 (2020),

Liu, P. P., Blet, A., Smyth, D. & Li, H. The science underlying COVID-19: implications for the cardiovascular system. Circulation 142, 68–78 (2020).

Lopez-Leon, S., Wegman-Ostrosky, T., Perelman,C. et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep2021; 11, 16144. https://doi.org/10.1038/s41598-021-95565-8

Ludwig Weckbach, Adrian Curta, Stephanie Bieber, et al. Inflammation and Dysfunction in COVID-19– Associated Myocardial Injury. Circulation: Cardiovascular Imaging. 2021;14:1 https://doi.org/10.1161/CIRCIMAGING.120.011713

M.A. de Graaf, M.L. Antoni, et al (2020) Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. https ://doi.org/10.1001/jamac ardio .2020.128

Maleszewski JJ, Young PM, Ackerman MJ, Halushka MK. An urgent need for studies of the late effects of SARS-CoV-2 on the cardiovascular system. Circulation 2021;143:1271e3.

Maurizio Galderisi, Bernard Cosyns, Thor Edvardsen, et al. Reviewers: This document was reviewed by members of the 2016–2018 EACVI Scientific Documents Committee, Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging, 2017;18(12),13011310. https://doi.org/10.1093/ehjci/jex244.

Mitrani RD., Dabas N., Goldberger JJ. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm. 2020;17(11):19841990. doi: 10.1016/j.hrthm.2020.06.026. Epub 2020 Jun 26. PMID: 32599178; PMCID: PMC7319645

Mohammad Said Ramadan, Lorenzo Bertolino, Rosa Zampino, Emanuele Durante-Mangoni. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review. Clinical Microbiology and Infection. 2021;27:1250e1261. https://doi.org/10.1016/j.cmi.2021.06.015

Nalbandian, A., Sehgal, K., Gupta, A. et al. Postacute COVID-19 syndrome. Nat Med. 2021; 27, 601–615. https://doi.org/10.1038/s41591-021-01283

Nicholas D’Elia, Stefano Caselli, et al. Normal Global Longitudinal Strain. An Individual Patient Meta-Analysis. JACC: CARDIOVASCULAR IMAGING. 2020;13:1. ISSN 1936-878X.

Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol 2020;17:543e58.

Obokata M, Nagata Y, Wu VC, et al. Direct comparison of cardiac magnetic resonance feature tracking and 2D/3D echocardiography speckle tracking for evaluation of global left ventricular strain. Eur Heart J Cardiovasc Imaging. 2016;17(5):525-32. doi: 10.1093/ehjci/ jev227. Epub 2015 Sep 15. PMID: 26377901.

ONS, August 5 Long Covid report,2021) https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/ovid19infectionintheuk/5august2021).

Özer S., Candan L., Özyıldız AG., Turan OE. Evaluation of left ventricular global functions with speckle tracking echocardiography in patients recovered from COVID-19. Int J Cardiovasc Imaging. 2021;37(7):22272233. doi: 10.1007/s10554-021-02211-5. Epub 2021 Mar 16. PMID: 33725265; PMCID: PMC7961169.

Phelan D, Kim JH, Elliott MD,et al. Screening of potential cardiac involvement in competitive athletes recovering from COVID-19: an Expert Consensus Statement. JACC Cardiovasc Imaging 2020;13:2635–2652).

Puntmann, M.L. Carerj, I. Wieters, M. Fahim, C. Arendt, J. Hoffmann, et al., Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19), JAMA Cardiol. (2020).

Raman B, Cassar MP, Tunnicliffe EM,et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021 Jan 7;31:100683. doi: 10.1016/j.eclinm.2020.100683. PMID: 33490928; PMCID: PMC7808914

Shmueli H, Shah M, Ebinger JE, et al. Left ventricular global longitudinal strain in identifying subclinical myocardial dysfunction among patients hospitalized with COVID-19. Int J Cardiol Heart Vasc. 2021;32:100719. doi:10.1016/j.ijcha.2021.100719

Sonnweber T, Sahanic S, Pizzini A, et al. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. Eur Respir J. 2021;29;57(4):2003481. doi: 10.1183/13993003.034812020. PMID: 33303539; PMCID: PMC7736754.

Ståhlberg M, Reistam U, Fedorowski A, et al. Post-Covid-19 Tachycardia Syndrome: A distinct phenotype of Post-acute Covid-19 Syndrome [published online ahead of print, 2021 Aug 11]. Am J Med. 2021;S00029343(21)00472-1. doi:10.1016/j.amjmed.2021.07.004

Vanichkachorn G, Newcomb R, et al. Post COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at the Mayo Clinic and Characteristics of the Initial Patient Cohort, Mayo Clinic Proceedings (2021), doi: https://doi.org/10.1016/j.mayocp.2021.04.024

Wang, H., Li, R., Zhou, Z. et al. Cardiac involvement in COVID-19 patients: mid-term follow up by cardiovascular magnetic resonance. J Cardiovasc Magn Reson , 2021;23, 14. https://doi.org/10.1186/s12968-021-00710-x

Wiersinga, A. Rhodes, A.C. Cheng et al. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review, JAMA. 2020; 324 (8),782–793.

Wu, Q. et al. Altered lipid metabolism in recovered SARS patients twelve years after infection. Sci. Rep. 2017; 7, 9110.

Xiong Q., Xu M., Li J., Liu Y., Zhang J., Xu Y. et al. Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect 2021;27:89e95.

Y. Li., H. Li., S. Zhu., Y. Xie, B. Wang, L. He, et al., Prognostic Value of Right Ventricular Longitudinal Strain in Patients with COVID-19. (2020) 3423.

Published

2022-04-08