tetano
Editor, Senior Moderator
ESC Heart Fail
. 2021 Mar 27.
doi: 10.1002/ehf2.13315. Online ahead of print.
Cardiac performance in patients hospitalized with COVID-19: a 6 month follow-up study
Antoine Fayol[SUP] 1 2 [/SUP], Marine Livrozet[SUP] 1 2 [/SUP], Pierre Boutouyrie[SUP] 1 3 [/SUP], Hakim Khettab[SUP] 3 [/SUP], Maureen Betton[SUP] 2 [/SUP], Victoria Tea[SUP] 4 [/SUP], Anne Blanchard[SUP] 2 [/SUP], Rosa-Maria Bruno[SUP] 1 3 [/SUP], Jean-S?bastien Hulot[SUP] 1 2 [/SUP], French COVID cohort study group
Affiliations
Abstract
Aims: Myocardial injury is frequently observed in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. Different cardiac abnormalities have been reported during the acute COVID-19 phase, ranging from infra-clinic elevations of myocardial necrosis biomarkers to acute cardiac dysfunction and myocarditis. There is limited information on late cardiac sequelae in patients who have recovered from acute COVID-19 illness. We aimed to document the presence and quantify the extent of myocardial functional alterations in patients hospitalized 6 months earlier for COVID-19 infection.
Methods and results: We conducted a prospective echocardiographic evaluation of 48 patients (mean age 58 ? 13 years, 69% male) hospitalized 6 ? 1 month earlier for a laboratory-confirmed and symptomatic COVID-19. Thirty-two (66.6%) had pre-existing cardiovascular risks factors (systemic hypertension, diabetes, or dyslipidaemia), and three patients (6.2%) had a known prior myocardial infarction. Sixteen patients (33.3%) experienced myocardial injury during the index COVID-19 hospitalization as identified by a rise in cardiac troponin levels. Six months later, 60.4% of patients still reported clinical symptoms including exercise dyspnoea for 56%. Echocardiographic measurements under resting conditions were not different between patients with versus without myocardial injury during the acute COVID-19 phase. In contrast, low-level exercise (25W for 3 min) induced a significant increase in the average E/e' ratio (10.1 ? 4.3 vs. 7.3 ? 11.5, P = 0.01) and the systolic pulmonary artery pressure (33.4 ? 7.8 vs. 25.6 ? 5.3 mmHg, P = 0.02) in patients with myocardial injury during the acute COVID-19 phase. Sensitivity analyses showed that these alterations of left ventricular diastolic markers were observed regardless of whether of cardiovascular risk factors or established cardiac diseases indicating SARS-CoV-2 infection as a primary cause.
Conclusions: Six months after the acute COVID-19 phase, significant cardiac diastolic abnormalities are observed in patients who experienced myocardial injury but not in patients without cardiac involvement.
Keywords: COVID-19; Diastolic function; Echocardiography; Heart failure; Myocarditis.
. 2021 Mar 27.
doi: 10.1002/ehf2.13315. Online ahead of print.
Cardiac performance in patients hospitalized with COVID-19: a 6 month follow-up study
Antoine Fayol[SUP] 1 2 [/SUP], Marine Livrozet[SUP] 1 2 [/SUP], Pierre Boutouyrie[SUP] 1 3 [/SUP], Hakim Khettab[SUP] 3 [/SUP], Maureen Betton[SUP] 2 [/SUP], Victoria Tea[SUP] 4 [/SUP], Anne Blanchard[SUP] 2 [/SUP], Rosa-Maria Bruno[SUP] 1 3 [/SUP], Jean-S?bastien Hulot[SUP] 1 2 [/SUP], French COVID cohort study group
Affiliations
- PMID: 33773099
- DOI: 10.1002/ehf2.13315
Abstract
Aims: Myocardial injury is frequently observed in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. Different cardiac abnormalities have been reported during the acute COVID-19 phase, ranging from infra-clinic elevations of myocardial necrosis biomarkers to acute cardiac dysfunction and myocarditis. There is limited information on late cardiac sequelae in patients who have recovered from acute COVID-19 illness. We aimed to document the presence and quantify the extent of myocardial functional alterations in patients hospitalized 6 months earlier for COVID-19 infection.
Methods and results: We conducted a prospective echocardiographic evaluation of 48 patients (mean age 58 ? 13 years, 69% male) hospitalized 6 ? 1 month earlier for a laboratory-confirmed and symptomatic COVID-19. Thirty-two (66.6%) had pre-existing cardiovascular risks factors (systemic hypertension, diabetes, or dyslipidaemia), and three patients (6.2%) had a known prior myocardial infarction. Sixteen patients (33.3%) experienced myocardial injury during the index COVID-19 hospitalization as identified by a rise in cardiac troponin levels. Six months later, 60.4% of patients still reported clinical symptoms including exercise dyspnoea for 56%. Echocardiographic measurements under resting conditions were not different between patients with versus without myocardial injury during the acute COVID-19 phase. In contrast, low-level exercise (25W for 3 min) induced a significant increase in the average E/e' ratio (10.1 ? 4.3 vs. 7.3 ? 11.5, P = 0.01) and the systolic pulmonary artery pressure (33.4 ? 7.8 vs. 25.6 ? 5.3 mmHg, P = 0.02) in patients with myocardial injury during the acute COVID-19 phase. Sensitivity analyses showed that these alterations of left ventricular diastolic markers were observed regardless of whether of cardiovascular risk factors or established cardiac diseases indicating SARS-CoV-2 infection as a primary cause.
Conclusions: Six months after the acute COVID-19 phase, significant cardiac diastolic abnormalities are observed in patients who experienced myocardial injury but not in patients without cardiac involvement.
Keywords: COVID-19; Diastolic function; Echocardiography; Heart failure; Myocarditis.