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Myocardial Dysfunction and Risk of Long COVID in Patients Recovered From Mild and Moderate COVID-19
Binyu Zhou1, Yiran Zhang1, Shuang Han1
1Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
Insights
Persistent cardiovascular symptoms after COVID-19 are linked to subtle myocardial dysfunction. Specific echocardiographic measures, including left atrial conduit strain and basal inferoseptal left ventricle longitudinal strain, predict symptom persistence.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Persistent cardiovascular symptoms are common in COVID-19 survivors.
- The extent of myocardial dysfunction and its predictors post-COVID-19 require further elucidation.
Purpose of the Study:
- To assess myocardial dysfunction in recovered COVID-19 patients.
- To identify predictors of persistent cardiovascular symptoms.
Main Methods:
- Echocardiograms of 546 recovered COVID-19 patients and 351 controls were analyzed.
- Myocardial strain parameters, including left ventricle global longitudinal strain (LVGLS), regional LVLS, and left atrial strains (LAS), were evaluated.
- Clinical follow-up at 12 months identified persistent symptoms; multivariable logistic regression pinpointed predictors.
Main Results:
- While LVGLS remained stable, regional LVLS and LAS showed significant reductions post-COVID-19.
- 16.5% of patients reported persistent cardiovascular symptoms at 1-year follow-up.
- LA conduit strain and basal inferoseptal LVLS were independently associated with persistent symptoms.
Conclusions:
- Subclinical myocardial dysfunction, marked by regional LVLS impairment and LAS reduction, persists post-COVID-19.
- LA conduit strain and basal inferoseptal LVLS are novel imaging markers for risk stratification.
- Findings support targeted echocardiographic surveillance and early interventions in post-COVID care.
Purpose:
Numerous recovered COVID-19 patients exhibit persistent cardiovascular symptoms. However, the degree of myocardial dysfunction and its associated risk factors remain unclear. This study aims to evaluate myocardial dysfunction in recovered patients and pinpoint predictors of persistent cardiovascular symptoms.
Methods:
We reviewed the echocardiograms of patients who recovered from mild or moderate COVID-19 and presented with cardiovascular symptoms during the Omicron surge. Myocardial strain was analyzed in 546 patients before and after infection, and in 351 prepandemic healthy controls. Clinical follow-up at 12 months post-infection was used to evaluated symptom persistence, and multivariable logistic regression was used to identify independent predictors.
Results:
Baseline characteristics showed no significant differences between patients and controls (all p > 0.05). Although the left ventricle global longitudinal strain (LVGLS) remained stable post-infection, significant reductions emerged in regional left ventricle longitudinal strains (LVLS) and all left atrial strains (LAS) (all p < 0.05). Persistent cardiovascular symptoms affected 16.5% (90/546) of patients at 1-year follow-up. Multivariate analysis showed that only LA conduit strain (OR = 0.919, 95% CI: 0.857, 0.985, p = 0.017) and basal inferoseptal LVLS (OR = 0.883, 95% CI: 0.792, 0.986, p = 0.026) correlated with persisting cardiovascular symptoms.
Conclusion:
Our findings demonstrate that subclinical but persistent COVID-19-associated myocardial dysfunction is characterized by regional LVLS impairment and LAS reduction. The identified strain parameters (LAScd and basal inferoseptal LVLS) serve as novel imaging markers for stratifying patients at risk of persistent cardiovascular symptoms. These results advocate for targeted echocardiographic surveillance and early intervention strategies in post-COVID care pathways.
Trial Registration:
ClinicalTrials.gov identifier: NCT06170307.
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