Cardiac Function and Functional Capacity in Patients With Long COVID: A Comparison to Propensity-Matched Community
Thomas H Marwick1, Noah Wexler2, Joel Smith3
1Imaging Research Lab, Baker Heart and Diabetes Institute, Hobart, Tasmania, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Royal Hobart Hospital, Hobart, Tasmania, Australia; Cardiovascular Health Flagship, Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Insights
Long COVID is linked to subclinical heart dysfunction, specifically altered left ventricular dimensions and impaired global longitudinal strain (GLS). This cardiac impairment is independent of traditional risk factors and contributes to functional limitations in patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- Cardiac impairment is a known complication of acute COVID-19.
- The role of cardiac dysfunction in long COVID (post-acute sequelae of COVID-19) remains unclear.
- Previous studies on cardiovascular involvement in long COVID often lack control groups.
Purpose of the Study:
- To compare cardiac dysfunction prevalence in long COVID patients versus non-infected controls.
- To investigate the association between cardiac dysfunction and functional capacity in long COVID.
Main Methods:
- Echocardiography was used to assess cardiac structure and function, including global longitudinal strain (GLS).
- 190 long COVID patients were compared to 979 historical controls using propensity score matching.
- Functional capacity was assessed using subjective (Duke Activity Status Index) and objective (6-minute walk test) measures.
Main Results:
- Long COVID patients exhibited altered left ventricular dimensions and geometry.
- Subclinical systolic dysfunction was identified in the long COVID group, indicated by significantly lower GLS and a higher prevalence of abnormal GLS.
- Long COVID was independently associated with both subjective and objective functional impairment, with a stronger association than traditional risk factors.
Conclusions:
- Impaired global longitudinal strain and altered left ventricular dimensions are key echocardiographic findings in long COVID.
- These cardiac changes are overrepresented in long COVID patients and are independent of other risk factors.
- While impaired GLS is weakly associated with functional impairment, long COVID itself is a strong independent predictor of functional deficits.
Background:
Cardiac impairment has been associated with acute COVID-19 since the earliest reports of the pandemic. However, its role in postacute sequelae of COVID-19 ("long COVID") is undefined, and many existing observations about cardiovascular involvement in postacute sequelae of COVID-19 are uncontrolled.
Objective:
To compare the prevalence of cardiac dysfunction in patients with long COVID and noninfected controls from the same community and explore their association with functional capacity.
Methods:
Echocardiography was used to assess cardiac structure and function, including the measurement of global longitudinal strain (GLS), in 190 participants with long COVID. All underwent assessment of functional impairment by subjective (Duke Activity Status Index) and objective tests (6-minute walk test). The 190 participants from the long COVID group were matched with those from 979 patients who underwent the same tests in the pre-COVID-19 era, using a propensity score.
Results:
The 190 patients with long COVID had similar age and risk factor profiles to those of their matched controls. Left ventricular dimensions and geometry, but not diastolic parameters, were significantly altered in the long COVID group. The long COVID group had subclinical systolic dysfunction (GLS 18.5% ± 2.6% vs 19.3% ± 2.7%, P = .005), and more long COVID patients had abnormal (<16%) GLS (13% vs 8%, P = .035). The association of long COVID with abnormal GLS (odds ratio, 1.49 [1.04, 2.45]) was independent of-and had a similar or greater effect size than-age and risk factors. There was no interaction of long COVID with the association of risk factors with GLS. As expected, the long COVID group had significant subjective (<85% predicted METS; 72% vs 5%, P < .001) and objective functional impairment (29% vs 24%, P = .026), but GLS was only weakly associated with both subjective (r = 0.30, P = .005) and objective (r = 0.21, P = .05) functional impairment. The presence of long COVID was independently associated with subjective (odds ratio = 159.7 [95% CI, 61.6-414.2]) and objective functional impairment (odds ratio = 2.8 [95% CI, 1.5-5.2]).
Conclusions:
Impaired GLS and left ventricular dimensions are the echocardiographic features that are overrepresented in long COVID, and this association is similar to and independent of other risk factors. Impaired GLS is weakly associated with functional impairment.
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