Dynamics of myocardial global longitudinal strain in patients with COVID-19 without significant baseline cardiovascular pathology

Abstract

Abstract Background/Introduction SARS-CoV-2 is notorious for its ability to cause damage to the respiratory system and myocardium, which can result in the development of acute respiratory distress syndrome and myocardial dysfunction. Purpose The aim of our study was to assess the interaction between the severity of COVID-19 and echocardiographic parameters of myocardial dysfunction, as well as lung ultrasound data. Methods 47 COVID-19 patients without signs of cardiovascular pathology were included in our study (33 in the moderate severity subgroup and 14 in the severe subgroup). All patients underwent comprehensive transthoracic echocardiography, including global longitudinal strain (GLS) of both ventricles, and lung ultrasound at days 1 and 9 of the disease. We used GLS cut-off values of 16% and 20% for LV and RV respectively. We performed the lung ultrasonography using an 8-zone protocol for each lung. The EACVI lung ultrasound scoring system for each region and ultrasound pattern was used. Results At day 1, patients in the severe subgroup had a greater tricuspid gradient (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,04) and systolic pulmonary artery pressure (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,02). Moreover, we noted a decrease in the GLS RV index in COVID-19-patients in comparison with the generally accepted reference values (18,45 [15,8; 21,0]). During the course of the disease, an increase in GLS RV was noted in both subgroups, which was especially pronounced among severe patients (18,5 [15,2; 21,1] vs. 20,2 [15,8; 22,0], p=0,038). Assessing the LV function, we noted a difference in the E/e (LV) ratio among severe and moderate subgroups (7,5 [6,8; 9,34] vs. 9,5 [7,7; 10,2], p=0,03). The GLS LV didn't differ between patient subgroups at day 1. We noted an increase in GLS LV at day 9 in both subgroups, but the difference reached significance among moderate patients (17,9 [15,8; 20,1] vs. 19,5 [17,1; 21,8], p=0,038). We observed a greater number of points assessing the B-lines among severe subgroup compared to moderate subgroup (19,5 [17,5; 26,5] vs. 13,0 [7,0; 18,0], p<0,01). Conclusion Among COVID-19 patients without an underlying cardiovascular pathology the transient decrease in LV and RV function assessed via GLS was observed even among patients with moderate disease severity. Funding Acknowledgement Type of funding sources: None.