Echocardiographic assessment of COVID19 sequelae in survivors with elevated cardiac biomarkers
Eduard Ródenas-Alesina1, José Rodríguez-Palomares2, Montse Bach-Oller1
1Cardiology Department, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Spain.
Insights
COVID-19 survivors with elevated cardiovascular biomarkers show minimal cardiac abnormalities, with no impact on management or short-term prognosis. Routine screening after discharge is not supported for this patient group.
Area of Science:
- Cardiology
- Infectious Diseases
- Echocardiography
Background:
- COVID-19 can cause cardiovascular complications.
- Elevated cardiovascular biomarkers (CVB) in COVID-19 patients may indicate cardiac injury.
- The long-term cardiac sequelae in these patients are not well understood.
Purpose of the Study:
- To determine the prevalence and type of cardiovascular sequelae after COVID-19 infection in patients with elevated cardiovascular biomarkers (CVB).
- To assess the prognostic implications of these sequelae using advanced echocardiography.
- To evaluate the need for routine cardiac screening in this population post-discharge.
Main Methods:
- Advanced echocardiography was used to assess cardiac structure and function.
- Patients admitted with COVID-19 and elevated CVB (hs-TnI, NT-proBNP, D-dimer) were matched with controls.
- Follow-up echocardiograms were performed to evaluate cardiac parameters and outcomes.
Main Results:
- No significant differences in left ventricular ejection fraction (LVEF) were observed between groups.
- Patients with elevated CVB showed slight differences in deformation parameters and lower myocardial work.
- Abnormal echocardiograms were more frequent in the elevated CVB group, primarily with mild abnormalities; no major cardiovascular events occurred within 7 months.
Conclusions:
- COVID-19 survivors with elevated CVB exhibit minimal cardiac abnormalities.
- These findings have no impact on patient management or short-term prognosis.
- Routine post-discharge screening is not recommended for this population.
Aims:
We sought to determine, using advanced echocardiography, the prevalence and type of cardiovascular sequelae after COVID19 infection with marked elevation of cardiovascular biomarkers (CVB), and their prognostic implications.
Methods:
All patients admitted from March 1st to May 25th, 2020 to a tertiary referral hospital were included. Those with cardiovascular diseases or dead during admission were excluded. Patients with hs-TnI > 45 ng/L, NT-proBNP>300 pg/mL, and D-dimer >8000 ng/mL were matched with COVID controls (three biomarkers within the normal range) based on intensive care requirements and age, and separately analyzed.
Results:
From 2025 patients, 80 patients with significantly elevated CVB and 29 controls were finally included. No differences in baseline characteristics were observed among groups, but elevated CVB patients were sicker. Follow-up echocardiograms showed no differences among groups regarding LVEF and only slight differences between groups within the normal range. Hs-TnI patients had lower myocardial work and longitudinal strain. The presence of an abnormal echocardiogram was more frequent in the elevated CVB group compared to controls (23.8 vs 10.3%, P = 0.123) but mainly associated with mild abnormalities in deformation parameters. Management did not change in any case and no major cardiovascular events except deep vein thrombosis occurred after a median follow-up of 7 months.
Conclusion:
Minimal abnormalities in cardiac structure and function are observed in COVID19 survivors without previous cardiovascular diseases who presented a significant CVB rise at admission, with no impact on patient management or short-term prognosis. These results do not support a routine screening program after discharge in this population.
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