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Cardiac structure and function 1.5 years after COVID-19: results from the EPILOC study
Jana Schellenberg1, Lynn Matits2,3, Daniel A Bizjak2
1Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, 89075, Ulm, Germany. jana.schellenberg@uniklinik-ulm.de.
Insights
Long COVID (PCS) patients show reduced left ventricular (LV) function and exercise capacity compared to recovered controls. These subtle cardiac changes, particularly LV global longitudinal strain (GLS), warrant further investigation for long-term health impacts.
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.
Purpose:
Impaired left and right ventricular (LV/RV) function during acute SARS-CoV-2 infection has been predominantly reported in hospitalized patients, but long-term cardiac sequelae in large, well-characterized cohorts remain inconclusive. This study evaluated cardiac structure and function in individuals with post-Coronavirus disease (COVID) syndrome (PCS) compared to recovered controls (CON), focusing on associations with cardiopulmonary symptoms and rapid physical exhaustion (RPE).
Methods:
This multicenter, population-based study included 1154 participants (679 PCS, 475 age- and sex matched CON; mean age 49 ± 12 years; 760 women) 1.5 years post-infection. Transthoracic echocardiography assessed LV global longitudinal strain (GLS), RV GLS and RV free wall strain (FWS), and other measures. Cardiopulmonary exercise testing (CPET) measured maximum respiratory oxygen uptake (VO2max) as a marker of cardiopulmonary fitness.
Results:
PCS participants exhibited significantly lower LV GLS (-20.25% [-21.28 - -19.22] vs. -20.73% [-21.74 - -19.72], p = 0.003), reduced diastolic function (E/A 1.16 [1.04-1.27] vs. 1.21 [1.1-1.32], p = 0.022) and decreased TAPSE (24.45 mm [22.14-26.77] vs. 25.05 mm [22.78-27.32], p = 0.022) compared to CON, even after adjusting for confounders. RV strain values were similar between groups. LV GLS correlated inversely with VO2max (p = 0.004) and positively with RPE (p = 0.050), though no associations were observed with other cardiopulmonary symptoms.
Conclusions:
This study demonstrates subtle yet consistent reductions in LV function, specifically LV GLS and diastolic function, and exercise capacity in PCS compared to CON. While these changes are within reference ranges, their potential impact on clinical outcomes warrants further investigation. These findings highlight the need for cardiac assessments and long-term follow-up in symptomatic PCS patients.
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