Cardiac Dysfunction and Arrhythmias 3 Months After Hospitalization for COVID-19
Charlotte B Ingul1,2, Jostein Grimsmo2, Albulena Mecinaj3
1Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.
Insights
Post-COVID-19 patients show impaired right ventricular function and increased diastolic dysfunction 3 months after discharge. Ventricular arrhythmias are common, but their clinical significance requires further investigation.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- Cardiac dysfunction is a known complication of COVID-19, but data on arrhythmic burden is limited.
- Understanding long-term cardiac effects is crucial for patient management post-COVID-19.
Purpose of the Study:
- To assess cardiac function and arrhythmic burden in patients 3-4 months after COVID-19 hospitalization.
- To compare cardiac parameters between COVID-19 survivors and matched controls.
Main Methods:
- Combined multicenter prospective cohort and cross-sectional case-control study.
- Echocardiography and 24-hour ECG were used to evaluate cardiac function and arrhythmias.
- 204 COVID-19 patients were compared with 204 matched controls.
Main Results:
- COVID-19 patients exhibited worse right ventricle function (RV free wall longitudinal strain, tricuspid annular plane systolic excursion) and lower cardiac index compared to controls.
- Diastolic dysfunction was twice as common in COVID-19 survivors (30% vs 15%).
- Arrhythmias, including premature ventricular contractions and nonsustained ventricular tachycardia, were found in 27% of patients.
Conclusions:
- Mild right ventricular impairment and increased diastolic dysfunction persist 3 months post-COVID-19 hospitalization.
- Cardiac function was not significantly associated with intensive care, dyspnea, or fatigue.
- The prevalence of ventricular arrhythmias warrants further study to determine clinical significance.
Abstract:
Background The extent of cardiac dysfunction post-COVID-19 varies, and there is a lack of data on arrhythmic burden. Methods and Results This was a combined multicenter prospective cohort study and cross-sectional case-control study. Cardiac function assessed by echocardiography in patients with COVID-19 3 to 4 months after hospital discharge was compared with matched controls. The 24-hour ECGs were recorded in patients with COVID-19. A total of 204 patients with COVID-19 consented to participate (mean age, 58.5 years; 44% women), and 204 controls were included (mean age, 58.4 years; 44% women). Patients with COVID-19 had worse right ventricle free wall longitudinal strain (adjusted estimated mean difference, 1.5 percentage points; 95% CI, -2.6 to -0.5; P=0.005) and lower tricuspid annular plane systolic excursion (-0.10 cm; 95% CI, -0.14 to -0.05; P<0.001) and cardiac index (-0.26 L/min per m2; 95% CI, -0.40 to -0.12; P<0.001), but slightly better left ventricle global strain (-0.8 percentage points; 95% CI, 0.2-1.3; P=0.008) compared with controls. Reduced diastolic function was twice as common compared with controls (60 [30%] versus 29 [15%], respectively; odds ratio, 2.4; P=0.001). Having dyspnea or fatigue were not associated with cardiac function. Right ventricle free wall longitudinal strain was worse after intensive care treatment. Arrhythmias were found in 27% of the patients, mainly premature ventricular contractions and nonsustained ventricular tachycardia (18% and 5%, respectively). Conclusions At 3 months after hospital discharge with COVID-19, right ventricular function was mildly impaired, and diastolic dysfunction was twice as common compared with controls. There was little evidence for an association between cardiac function and intensive care treatment, dyspnea, or fatigue. Ventricular arrhythmias were common, but the clinical importance is unknown. Registration URL: http://clinicaltrials.gov. Unique Identifier: NCT04535154.
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