Subclinical Left Ventricular Systolic Dysfunction in Hospitalized Patients with COVID-19 by Strain: A 30-Day
Pedro Morillas-Blasco1, Paula Guedes-Ramallo1, Nuria Vicente-Ibarra1
1Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain.
Insights
Subclinical left ventricular dysfunction, detected by global longitudinal strain, is common in noncritical COVID-19 patients. This cardiac impairment often improves within 30 days of recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Echocardiography
Background:
- Myocardial injury is a known complication of COVID-19, linked to increased mortality.
- Echocardiographic data on subclinical left ventricular dysfunction in COVID-19 patients are limited.
- Global longitudinal strain (GLS) is a sensitive measure for detecting early left ventricular dysfunction.
Purpose of the Study:
- To identify subclinical left ventricular dysfunction using GLS in hospitalized COVID-19 patients.
- To assess the short-term evolution of left ventricular dysfunction in these patients.
Main Methods:
- Thirty-one noncritical COVID-19 patients underwent transthoracic echocardiography.
- Left ventricular global longitudinal strain (GLS) was measured at acute stage and 30-day follow-up.
- Abnormal GLS was defined as <-15.9%; myocardial injury indicated by elevated troponin.
Main Results:
- 35.5% of patients exhibited reduced GLS despite preserved left ventricular ejection fraction.
- Reduced GLS correlated with higher troponin and NT-proBNP levels.
- Myocardial injury was significantly associated with impaired GLS values.
Conclusions:
- Subclinical left ventricular dysfunction is prevalent in noncritical COVID-19 patients (1 in 3).
- This dysfunction is associated with myocardial injury markers.
- Impaired GLS tends to be reversible by 30-day follow-up, coinciding with clinical recovery.
Abstract:
Background and Objectives: Available studies confirm myocardial injury and its association with mortality in patients with COVID-19, but few data have been reported from echocardiographic studies. The aim of this study was to identify subclinical left ventricular dysfunction by global longitudinal strain (GLS) and its evolution in the short term in hospitalized patients with COVID-19. Materials and Methods: Thirty-one consecutive noncritical patients admitted for COVID-19 were included. Information on demographics, laboratory results, comorbidities, and medications was collected. Transthoracic echocardiograms were performed using a Philips Affinity 50, at the acute stage and at a 30-day follow-up. Automated left ventricular GLS was measured using a Philips Qlab 13.0. A GLS of <-15.9% was defined as abnormal. Results: The mean age was 65 ± 15.2 years, and 61.3% of patients were male. Nine patients (29%) had elevated levels of high-sensitivity troponin I. Left ventricular ejection fraction was preserved in all; however, 11 of them (35.5%) showed reduced GLS. These patients had higher troponin levels (median, 23.7 vs. 3.2 ng/L; p < 0.05) and NT-proBNP (median, 753 vs. 81 pg/mL; p < 0.05). The multivariate analysis revealed that myocardial injury, defined as increased troponin, was significantly associated with GLS values (coefficient B; p < 0.05). Follow-up at 30 days showed an improvement in GLS values in patients with subclinical left ventricular dysfunction (-16.4 ± 2.07% vs. -13.2 ± 2.40%; p < 0.01), without changes in the normal GLS group. Conclusions: Subclinical left ventricular dysfunction is common in noncritical hospitalized patients with COVID-19 (one in every three patients), even with preserved left ventricular ejection fraction. This impairment tends to be reversible on clinical recovery.
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