Cardiac structure and function 1.5 years after COVID-19: results from the EPILOC study

Area of Science:

• Cardiology
• Infectious Diseases
• Pulmonology

Background:

• Acute SARS-CoV-2 infection can impair left and right ventricular (LV/RV) function, primarily in hospitalized patients.
• Long-term cardiac sequelae in large cohorts with post-Coronavirus disease (COVID) syndrome (PCS) remain incompletely understood.
• Previous studies have not conclusively determined the extent of cardiac dysfunction post-COVID-19.

Purpose of the Study:

• To evaluate cardiac structure and function in individuals with PCS compared to recovered controls (CON) 1.5 years post-infection.
• To investigate the associations between cardiac function, cardiopulmonary symptoms, and rapid physical exhaustion (RPE) in PCS patients.
• To determine if subtle cardiac impairments persist in individuals experiencing long COVID symptoms.

Main Methods:

• A multicenter, population-based study involving 1154 participants (679 PCS, 475 CON) approximately 1.5 years after infection.
• Transthoracic echocardiography was used to assess LV global longitudinal strain (GLS), RV GLS, RV free wall strain (FWS), and diastolic function.
• Cardiopulmonary exercise testing (CPET) measured maximum respiratory oxygen uptake (VO2max) to assess cardiopulmonary fitness.

Main Results:

• PCS participants demonstrated significantly lower LV GLS, reduced diastolic function (E/A ratio), and decreased TAPSE compared to CON, even after adjusting for confounders.
• Right ventricular (RV) strain values were comparable between PCS and CON groups.
• LV GLS showed an inverse correlation with VO2max and a positive correlation with RPE, indicating impaired cardiac function is linked to reduced exercise capacity and exhaustion.

Conclusions:

• Subtle but consistent reductions in LV function (GLS, diastolic function) and exercise capacity are evident in individuals with PCS.
• These cardiac changes, although within normal reference ranges, may have clinical implications and require further study.
• Cardiac assessments and long-term follow-up are recommended for symptomatic PCS patients to monitor potential long-term cardiovascular effects.