Patients recovering from COVID-19 showed cardiac dysfunction on trans-thoracic echocardiography three to four months after hospital discharge, according to a Norwegian study in the Journal of the American Heart Association.
Compared with matched controls, 204 COVID patients had worse right ventricular longitudinal strain (RVLS; adjusted estimated mean difference 1.5 percentage points, lower tricuspid annular plane systolic excursion, and reduced cardiac index, reported Dr Charlotte Ingul, PhD, of the Norwegian University of Science and Technology in Trondheim, and colleagues.
Reduced diastolic function was twice as likely among people post-COVID, with largely mild diastolic dysfunction, the researchers noted.
On the other hand, the COVID group had slightly better left ventricular (LV) global longitudinal strain (LV GLS; -0,8 percentage points compared with controls, in line with other studies showing little LV dysfunction after COVID.
Ingul and colleagues also analysed 24-hour ECGs from the patients with COVID, 27% of whom were found to have arrhythmias. It is unclear how these arrhythmias, mainly premature ventricular contractions (18%) and non-sustained ventricular tachycardia (5%), related to COVID-19, they acknowledged.
This cohort study was based on the PROLUN project at six Norwegian centres and included 204 patients (mean age 58,5 years, 44% women) who volunteered for the study after being hospitalised with COVID-19 from February to June 2020.
Controls consisted of 204 participants from the fourth wave of the Trøndelag Health Study, matched by age, sex, BMI, systolic blood pressure, and comorbidities.
For the participating COVID patients, echocardiograms were performed a median of 102 days after discharge from the hospital.
Persistent dyspnea and fatigue were common among patients, and were not associated with cardiac dysfunction.
Those who required admission to the ICU had slightly worse RVLS than those not requiring intensive care, but had largely similar cardiac function otherwise. Ingul’s team cautioned that RVLS and LV GLS could not be analysed in 19% and 8% of patients, respectively, and that participants self-reported history of hypertension and cardiac disease.
A previous case-control study did not find that cardiac structure and function were impaired in patients 6 months after mild COVID-19 illness.
Study details
Cardiac Dysfunction and Arrhythmias 3 Months After Hospitalization for COVID‐19
Charlotte B. Ingul, Jostein Grimsmo, Albulena Mecinaj, Divna Trebinjac, Magnus Berger Nossen, Simon Andrup, Bjørnar Grenne, Håvard Dalen, Gunnar Einvik, Knut Stavem, Turid Follestad, Tony Josefsen, Torbjørn Omland, and Torstein Jensen.
Published in the Journal of the American Heart Association on 20 January 2022
Abstract
Background
The extent of cardiac dysfunction post‐COVID‐19 varies, and there is a lack of data on arrhythmic burden.
Methods and Results
This was a combined multicentre prospective cohort study and cross‐sectional case‐control study. Cardiac function assessed by echocardiography in patients with COVID‐19 3 to 4 months after hospital discharge was compared with matched controls. The 24‐hour ECGs were recorded in patients with COVID‐19. A total of 204 patients with COVID‐19 consented to participate (mean age, 58.5 years; 44% women), and 204 controls were included (mean age, 58.4 years; 44% women). Patients with COVID‐19 had worse right ventricle free wall longitudinal strain (adjusted estimated mean difference, 1.5 percentage points; 95% CI, −2.6 to −0.5; P=0.005) and lower tricuspid annular plane systolic excursion (−0.10 cm; 95% CI, −0.14 to −0.05; P<0.001) and cardiac index (−0.26 L/min per m2; 95% CI, −0.40 to −0.12; P<0.001), but slightly better left ventricle global strain (−0.8 percentage points; 95% CI, 0.2–1.3; P=0.008) compared with controls. Reduced diastolic function was twice as common compared with controls (60 [30%] versus 29 [15%], respectively; odds ratio, 2.4; P=0.001). Having dyspnea or fatigue were not associated with cardiac function. Right ventricle free wall longitudinal strain was worse after intensive care treatment. Arrhythmias were found in 27% of the patients, mainly premature ventricular contractions and nonsustained ventricular tachycardia (18% and 5%, respectively).
Conclusions
At 3 months after hospital discharge with COVID‐19, right ventricular function was mildly impaired, and diastolic dysfunction was twice as common compared with controls. There was little evidence for an association between cardiac function and intensive care treatment, dyspnea, or fatigue. Ventricular arrhythmias were common, but the clinical importance is unknown.
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