Impaired Right Ventricular Longitudinal Strain Without Pulmonary Hypertension in Patients Who Have Recovered From COVID-19

HomeCirculation: Cardiovascular ImagingVol. 14, No. 4Impaired Right Ventricular Longitudinal Strain Without Pulmonary Hypertension in Patients Who Have Recovered From COVID-19 Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBImpaired Vincenzo Nuzzi, Matteo Castrichini, Valentino Collini, Erik Roman-Pognuz, Stefano Di Bella, Roberto Luzzati, Giorgio Berlot, Marco Confalonieri, Merlo, Davide Stolfo and Gianfranco Sinagra NuzziVincenzo Nuzzi https://orcid.org/0000-0002-9643-2697 Department of Cardiology (V.N., M. V.C., M.M., D.S., G.S.), Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University Trieste, Italy. *V. Castrichini contributed equally. Search for more papers by this author , CastrichiniMatteo https://orcid.org/0000-0002-2405-3364 ColliniValentino Collini Roman-PognuzErik Roman-Pognuz https://orcid.org/0000-0002-0859-3424 Anesthesia Intensive Care Medicine (E.R.-P., G.B.), BellaStefano Bella https://orcid.org/0000-0001-6121-7009 Infectious Diseases (S.D.B., R.L.), LuzzatiRoberto Luzzati https://orcid.org/0000-0001-5546-0715 BerlotGiorgio Berlot ConfalonieriMarco Confalonieri Pneumology (M. Confalonieri), MerloMarco Merlo StolfoDavide Stolfo, MD, Division Cardiology, Department, Giuliana Via Valdoni 7, 34149 Email E-mail Address: [email protected] https://orcid.org/0000-0002-4538-6811 SinagraGianfranco Originally published8 Apr 2021https://doi.org/10.1161/CIRCIMAGING.120.012166Circulation: Imaging. 2021;14:e012166Other version(s) articleYou are viewing the most recent version article. Previous versions: April 8, 2021: Ahead Print ventricular (RV) dysfunction (RVD) is associated with worse outcome coronavirus disease 2019 (COVID-19).1 hypertension (PH) a cause RVD respiratory failure negative prognosis.2 Major pulmonary embolism, alveolar endothelial injury, thrombotic microangiopathy potential triggers new-onset PH acute phase.3Persistent RV involvement has been reported patients recovered from COVID-19.4 However, association between persistent impairment remains unexplored. We evaluated prevalence COVID-19.The data that support findings study available corresponding upon reasonable request. All severe (ie, arterial oxygen saturation, <90%) without preexisting cardiovascular or lung discharged our hospital February September 2020 were offered opportunity perform an echocardiography, including speckle-tracking imaging (admission-to-echo time, 74 [51–98] days).COVID-19 infection diagnosis was made polymerase chain reaction nasopharyngeal swabs. A healthy age-, sex-, hypertension-matched cohort used as comparison.Echocardiograms analyzed according current recommendations4 using TomTec 2D Cardiac Performance Analysis software. defined fractional area shortening <35%, estimated artery systolic pressure >35 mm Hg, impaired longitudinal free-wall strain (RVLS) values >−20% (less negative).5 poor acoustic windows inadequate tricuspid regurgitation estimation excluded.Data mean±SD, median interquartile range, number percentages. Comparison performed ANOVA χ2 test. The complied Declaration Helsinki approved institutional ethics board. provided informed consent.Among 136 disease, 20 died, 21 declined participation study, 19 had tricuspid, while 23 not follow-up. Fifty-three included (61±12 years; 64% men; 38% required invasive ventilation; in-hospital stay, [10–28] days; Table).Table. Overall Characteristics Study PopulationCOVID (n=53)Control (n=37)P valueAge, y61 (12)58 (12)0.255Male sex, n (%)34 (64)26 (70)0.545Atrial fibrillation, (%)3 (6)3 (8)0.479Diabetes type 2, (%)12 (23)5 (14)0.209Smoker (active former), (%)8 (15)8 (22)0.425Hypertension, (%)22 (42)18 (49)0.502Troponin, ng/mL*11 (11)……CRP, mg/L49 (14–108)……d-dimer, mg/L FEU0.61 (0.46–1.04)……Invasive mechanical ventilation, (%)†20 (38)……Invasive ventilation duration, d12 (7–18)……Noninvasive (%)†27 (51)……Follow-up dataFollow-up d74 (51–98)……Systolic blood pressure, Hg136 (16)126 (14)0.005Heart rate, bpm72 (10)69 (15)0.289Oxygen saturation (room air), %98 (1)……β-Blocker, (23)17 (46)0.020ACE inhibitor/ARB, (%)17 (32)9 (24)0.392Mineralocorticoid antagonist, (%)1 (2)0 (0)0.589Diuretics, (%)4 (8)0 (0)0.115LVEDV, mL88 (28)92 (23)0.573LVEF, %63 (6)63 (7)0.878Diastolic grade 148 (91)30 (81)0.105E/E′9 (4)9 (2)0.408LAESV, mL53 (28)74 (24)0.003RAESA, cm215 (4)18 (4)0.002RVEDA, cm218 (4)17 (3)0.112RV-FAC, %44 (5)46 (6)0.124RV dysfunction, (%)0 (0)0 (0)…TAPSE, mm22 (4)25 (4)0.056RV S′, cm/s12 (2)13 (2)0.572RV strain−19.7 (−3.6)−22.1 (−1.5)<0.001Reduced strain, (42)0 (0)…PASP, Hg27 (6)28 (5)0.588Pulmonary PASP Hg), (0)…ACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; COVID, disease; CRP, C-reactive protein; FEU, fibrinogen equivalence unit; LAESV left atrial end-systolic volume; LVEDV, end-diastolic LVEF, ejection fraction; pressure; RAESA, right area; ventricle; RV-FAC shortening; RVEDA TAPSE anulus peak excursion.* Fourteen 53 troponin assessment available. Among these, 3 abnormal value (2 reduced strain) 9 normal strain).† Five received both noninvasive ventilation.No significant valvulopathies, diastolic >1, (pulmonary 27±6 (RV shortening, 44±5%). RVLS found 42% cases. similar mechanically ventilated nonmechanically (−19.7±−3.9% versus −19.6±−2.1%; P=0.942). No heart symptoms at follow-up.Control subjects (n=37) showed RVLS. In COVID-recovered patients, lower (P<0.001) compared controls.The high phase reported.2 hypothesized increased burden thromboembolic complications induced might complicate PH. despite presentation, no after recovery RVD. Nevertheless, deformation revealed independent afterload determined Potential explanations finding be related concomitant factors myocardial inflammation (direct viral injury inflammatory response), ischemic damage due oxygenation, ventilation-induced trauma lead subclinical injury.3. Recently, magnetic resonance demonstrated cardiac >50% patients. these functional parameters concomitantly impaired.5Some limitation should acknowledged. population size retrospective nature limit strength observations. Biomarkers only minority cohort. Moreover, did have previous echocardiographic evaluations; therefore, trends feasible.Although symptomatic conventional echo parameters, noted Long-term follow-up define evolution abnormalities, larger series warranted validate findings.AcknowledgmentsWe thank Cassa di Risparmio Trieste Foundation continuous research.Sources FundingNone.Disclosures None.Footnotes*V. equally.Davide davide.[email protected]comReferences1. Li Y, H, Zhu S, Xie Wang B, He L, Zhang D, Yuan Wu Cet al. Prognostic COVID-19.JACC Cardiovasc 2020; 13:2287–2299. doi: 10.1016/j.jcmg.2020.04.014CrossrefMedlineGoogle Scholar2. Pagnesi M, Baldetti Beneduce A, Calvo F, Gramegna Pazzanese V, Ingallina G, Napolano Finazzi R, Ruggeri et hospitalised COVID-19.Heart. 106:1324–1331. 10.1136/heartjnl-2020-317355CrossrefMedlineGoogle Scholar3. Pellikka PA, Naqvi TZ. ventricle: target insult.J Am Coll Cardiol. 76:1978–1981. 10.1016/j.jacc.2020.09.529CrossrefMedlineGoogle Scholar4. Huang Zhao P, Tang T, Han Zhan C, Liu W, Zeng Tao Q, Xia Let COVID-2019 identified imaging.JACC 13:2330–2339. 10.1016/j.jcmg.2020.05.004CrossrefMedlineGoogle Scholar5. Lang RM, Badano LP, Mor-Avi Afilalo J, Armstrong Ernande Flachskampf FA, Foster E, Goldstein SA, Kuznetsova Recommendations chamber quantification echocardiography adults: update American Society Echocardiography European Association Imaging.Eur Heart J 2015; 16:233–270. 10.1093/ehjci/jev014CrossrefMedlineGoogle Scholar Back top Next FiguresReferencesRelatedDetailsCited By Barros Castillo Lacerda H (2023) Abnormal syndrome COVID‐19, Echocardiography, 10.1111/echo.15538, 40:3, (227-234), Online publication date: 1-Mar-2023. Jordan-Rios Bromage McDonagh G Cannata Reshaping care aftermath pandemic. Implications cardiology health systems, Journal Internal Medicine, 10.1016/j.ejim.2022.11.029, 109, (4-11), Parhizgar Yazdankhah N, Rzepka Chung K, Ali I, Lai Russell V Cheung Beyond COVID-19: review long-term outcomes, Canadian 10.1016/j.cjca.2023.01.031, 1-Feb-2023. 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Maestre-Muñiz Arias Á, Mata-Vázquez Martín-Toledano López-Larramona Ruiz-Chicote Nieto-Sandoval B Lucendo Outcomes One Year Hospital Discharge, 10.3390/jcm10132945, 10:13, (2945) 2021Vol Issue 4 Advertisement Article InformationMetrics © 2021 Association, Inc.https://doi.org/10.1161/CIRCIMAGING.120.012166PMID: 33827250 publishedApril KeywordsCOVID-19echocardiographyhypertension, pulmonaryprognosisventricular function, rightPDF download SubjectsContractile FunctionEchocardiographyImagingUltrasound