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Cardiopulmonary Long-Term Sequelae in Patients after Severe COVID-19 Disease
Julia Hanne Niebauer1, Christina Binder-Rodriguez2, Ahmet Iscel1
1Department of Cardiology, Favoriten Clinic, 1100 Vienna, Austria.
Insights
Long-term effects of severe COVID-19 are common, with most patients experiencing Long-COVID symptoms six months post-discharge. Exertional dyspnea is linked to cardiopulmonary issues, while hospital stay length and ICU admission predict Long-COVID development.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
Background:
- Severe COVID-19 can lead to persistent health issues, impacting cardiopulmonary function.
- Long-COVID is a recognized post-viral syndrome with diverse manifestations.
Purpose of the Study:
- To investigate long-term cardiopulmonary effects following severe COVID-19.
- To identify predictors of developing Long-COVID.
Main Methods:
- Prospective registry of 150 hospitalized patients, assessed 6 months post-discharge.
- Utilized echocardiography, MRI, pulmonary function tests, and CT scans.
- Clinical follow-up included symptom assessment and biomarker analysis (NT-proBNP).
Main Results:
- 75% met Long-COVID criteria; 49% reported fatigue, 38% exertional dyspnea.
- Cardiopulmonary abnormalities included reduced global longitudinal strain (GLS) (11%), diastolic dysfunction (4%), pericardial effusion (18%), and impaired pulmonary function (11%).
- Exertional dyspnea correlated with impaired pulmonary function, reduced GLS, and/or diastolic dysfunction. Predictors of Long-COVID: longer hospital stay, ICU admission, and higher NT-proBNP.
Conclusions:
- A majority of severe COVID-19 survivors experience Long-COVID symptoms 6 months post-discharge.
- Exertional dyspnea is a key indicator of underlying cardiopulmonary dysfunction.
- Hospitalization duration, ICU stay, and elevated NT-proBNP are significant predictors of Long-COVID.
Abstract:
We aimed to identify cardiopulmonary long-term effects after severe COVID-19 disease as well as predictors of Long-COVID in a prospective registry. A total of 150 consecutive, hospitalized patients (February 2020 and April 2021) were included six months post hospital discharge for a clinical follow-up. Among them, 49% experienced fatigue, 38% exertional dyspnea and 75% fulfilled criteria for Long-COVID. Echocardiography detected reduced global longitudinal strain (GLS) in 11% and diastolic dysfunction in 4%. Magnetic resonance imaging revealed traces of pericardial effusion in 18% and signs of former pericarditis or myocarditis in 4%. Pulmonary function was impaired in 11%. Chest computed tomography identified post-infectious residues in 22%. Whereas fatigue did not correlate with cardiopulmonary abnormalities, exertional dyspnea was associated with impaired pulmonary function (OR 3.6 [95% CI: 1.2-11], p = 0.026), reduced GLS (OR 5.2 [95% CI: 1.6-16.7], p = 0.003) and/or left ventricular diastolic dysfunction (OR 4.2 [95% CI: 1.03-17], p = 0.04). Predictors of Long-COVID included length of in-hospital stay (OR: 1.15 [95% CI: 1.05-1.26], p = 0.004), admission to intensive care unit (OR cannot be computed, p = 0.001) and higher NT-proBNP (OR: 1.5 [95% CI: 1.05-2.14], p = 0.026). Even 6 months after discharge, a majority fulfilled criteria for Long-COVID. While no associations between fatigue and cardiopulmonary abnormalities were found, exertional dyspnea correlated with impaired pulmonary function, reduced GLS and/or diastolic dysfunction.
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