Left ventricular global longitudinal strain as an indicator of myocardial injury in non-hospitalized COVID-19 survivors

Abstract

IntroductionThe incidence of acute cardiac injury in COVID-19 patients is frequently subclinical and can be identified by cardiac magnetic resonance imaging. Left ventricular global longitudinal strain (LV-GLS) using two-dimensional speckle-tracking echocardiography (2D-STE) provides an accurate validated method for early detection of subclinical myocardial dysfunction. So far, long-term cardiovascular complications of COVID-19 are undetermined therefore several validated methods should be used for early diagnosis and intervention in those patients.PurposeThe aim of this work was to describe GLS as an indicator of myocardial injury in a case series of non-hospitalized COVID-19 patients complaining of persistent dyspnea after resolution of COVID-19 infection.MethodsA total number of 18 patients who were diagnosed with COVID-19 and were not indicated for hospital admission due to mild symptoms presenting with residual persistent dyspnea following COVID-19 infection resolution. Through clinical examination and standard 2D transthoracic echocardiography with STE emphasizing on LV-GLS was performed using Philips Epic - Qlab 10 software.ResultsThe mean age of the included patients was 37.44±6.33 years, the mean time from COVID-19 diagnosis was 48.1±15.45 days, all patients (100%) had persistent dyspnea grade II. The mean left ventricular ejection fraction (LVEF) was 62.9±3.46% while the mean LV-GLS was −15.55±2.16%. Clinical and echocardiographic data is presented in Table 1.ConclusionIn a case series of non-hospitalized COVID-19 survivors who complained of persistent dyspnea, GLS was low in comparison to the normally reported values of LV-GLS although they had normal LVEF indicating the persistence of myocardial injury even in mild cases of COVID-19 long after infection resolution. Further close follow-up of even mild and moderate COVID-19 survivors is certainly required to detect long-term cardiovascular sequelae. 2D STE with LV-GLS can be used as a readily available validated technique to detect early or persistent myocardial dysfunction succeeding COVID-19 infection.Funding AcknowledgementType of funding sources: None.