DOI QR코드

DOI QR Code

Cardiac Phenotyping of SARS-CoV-2 in British Columbia: A Prospective Echo Study With Strain Imaging

  • Jeffrey Yim (Division of Cardiology, University of British Columbia) ;
  • Michael Y.C. Tsang (Division of Cardiology, University of British Columbia) ;
  • Anand Venkataraman (Division of Cardiology, University of British Columbia) ;
  • Shane Balthazaar (Division of Cardiology, University of British Columbia) ;
  • Ken Gin (Division of Cardiology, University of British Columbia) ;
  • John Jue (Division of Cardiology, University of British Columbia) ;
  • Parvathy Nair (Division of Cardiology, University of British Columbia) ;
  • Christina Luong (Division of Cardiology, University of British Columbia) ;
  • Darwin F. Yeung (Division of Cardiology, University of British Columbia) ;
  • Robb Moss (Division of Cardiology, University of British Columbia) ;
  • Sean A Virani (Division of Cardiology, University of British Columbia) ;
  • Jane McKay (Department of Medicine, University of British Columbia) ;
  • Margot Williams (Division of Cardiology, University of British Columbia) ;
  • Eric C. Sayre (Arthritis Research Canada) ;
  • Purang Abolmaesumi (Department of Electrical and Computer Engineering, University of British Columbia) ;
  • Teresa S.M. Tsang (Division of Cardiology, University of British Columbia)
  • 투고 : 2022.10.16
  • 심사 : 2023.01.29
  • 발행 : 2023.07.27

초록

BACKGROUND: There is limited data on the residual echocardiographic findings including strain analysis among post-coronavirus disease (COVID) patients. The aim of our study is to prospectively phenotype post-COVID patients. METHODS: All patients discharged following acute COVID infection were systematically followed in the post-COVID-19 Recovery Clinic at Vancouver General Hospital and St. Paul's Hospital. At 4-18 weeks post diagnosis, patients underwent comprehensive echocardiographic assessment. Left ventricular ejection fraction (LVEF) was assessed by 3D, 2D Biplane Simpson's, or visual estimate. LV global longitudinal strain (GLS) was measured using a vendor-independent 2D speckle-tracking software (TomTec). RESULTS: A total of 127 patients (53% female, mean age 58 years) were included in our analyses. At baseline, cardiac conditions were present in 58% of the patients (15% coronary artery disease, 4% heart failure, 44% hypertension, 10% atrial fibrillation) while the remainder were free of cardiac conditions. COVID-19 serious complications were present in 79% of the patients (76% pneumonia, 37% intensive care unit admission, 21% intubation, 1% myocarditis). Normal LVEF was seen in 96% of the cohort and 97% had normal right ventricular systolic function. A high proportion (53%) had abnormal LV GLS defined as < 18%. Average LV GLS of septal and inferior segments were lower compared to that of other segments. Among patients without pre-existing cardiac conditions, LVEF was abnormal in only 1.9%, but LV GLS was abnormal in 46% of the patients. CONCLUSIONS: Most post-COVID patients had normal LVEF at 4-18 weeks post diagnosis, but over half had abnormal LV GLS.

키워드

과제정보

We would like to acknowledge the Post-COVID-19 Recovery Clinic at St. Paul's Hospital and Vancouver General Hospital for their contribution to this study.

참고문헌

  1. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020;20:533-4.
  2. Clark A, Jit M, Warren-Gash C, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health 2020;8:e1003-17.
  3. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation 2020;141:1648-55.
  4. Dweck MR, Bularga A, Hahn RT, et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging 2020;21:949-58.
  5. Choi JH, Park JH. Things you should know in the performing echocardiographic examination in patients with COVID-19. J Cardiovasc Imaging 2021;29:20-30.
  6. Bitar ZI, Shamsah M, Bamasood OM, Maadarani OS, Alfoudri H. Point-of-care ultrasound for COVID-19 pneumonia patients in the ICU. J Cardiovasc Imaging 2021;29:60-8.
  7. Collier P, Phelan D, Klein A. A test in context: myocardial strain measured by speckle-tracking echocardiography. J Am Coll Cardiol 2017;69:1043-56.
  8. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14.
  9. Di Stefano C, Bruno G, Arciniegas Calle MC, et al. Diagnostic and predictive value of speckle tracking echocardiography in cardiac sarcoidosis. BMC Cardiovasc Disord 2020;20:21.
  10. Sonnweber T, Sahanic S, Pizzini A, et al. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. Eur Respir J 2021;57:2003481.
  11. Sechi LA, Colussi G, Bulfone L, et al. Short-term cardiac outcome in survivors of COVID-19: a systematic study after hospital discharge. Clin Res Cardiol 2021;110:1063-72.
  12. Zhou M, Wong CK, Un KC, et al. Cardiovascular sequalae in uncomplicated COVID-19 survivors. PLoS One 2021;16:e0246732.
  13. Lassen MC, Skaarup KG, Lind JN, et al. Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study. ESC Heart Fail 2020;7:4189-97.
  14. Bursi F, Santangelo G, Sansalone D, et al. Prognostic utility of quantitative offline 2D-echocardiography in hospitalized patients with COVID-19 disease. Echocardiography 2020;37:2029-39.
  15. Li X, Wang H, Zhao R, et al. Elevated extracellular volume fraction and reduced global longitudinal strains in participants recovered from COVID-19 without clinical cardiac findings. Radiology 2021;299:E230-40.
  16. Ozer PK, Govdeli EA, Baykiz D, et al. Impairment of right ventricular longitudinal strain associated with severity of pneumonia in patients recovered from COVID-19. Int J Cardiovasc Imaging 2021;37:2387-97.
  17. Sperry BW, Sato K, Phelan D, et al. Regional variability in longitudinal strain across vendors in patients with cardiomyopathy due to increased left ventricular wall thickness. Circ Cardiovasc Imaging 2019;12:e008973.
  18. Faqihi F, Alharthy A, Alshaya R, et al. Reverse takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: a case-report. BMC Cardiovasc Disord 2020;20:389.
  19. Sala S, Peretto G, Gramegna M, et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur Heart J 2020;41:1861-2.
  20. Shmueli H, Shah M, Ebinger JE, et al. Left ventricular global longitudinal strain in identifying subclinical myocardial dysfunction among patients hospitalized with COVID-19. Int J Cardiol Heart Vasc 2021;32:100719.
  21. Huang L, Zhao P, Tang D, et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. JACC Cardiovasc Imaging 2020;13:2330-9.
  22. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol 2009;53:1475-87.
  23. Lala A, Johnson KW, Januzzi JL, et al. Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection. J Am Coll Cardiol 2020;76:533-46.
  24. Oudit GY, Kassiri Z, Jiang C, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest 2009;39:618-25.
  25. Liu PP, Blet A, Smyth D, Li H. The science underlying COVID-19: implications for the cardiovascular system. Circulation 2020;142:68-78.
  26. Lindner D, Fitzek A, Brauninger H, et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol 2020;5:1281-5.
  27. Musher DM, Abers MS, Corrales-Medina VF. Acute infection and myocardial infarction. N Engl J Med 2019;380:171-6.
  28. Peng W, Wu H, Tan Y, Li M, Yang D, Li S. Mechanisms and treatments of myocardial injury in patients with corona virus disease 2019. Life Sci 2020;262:118496.
  29. Kwong JC, Schwartz KL, Campitelli MA, et al. Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med 2018;378:345-53.
  30. Giustino G, Pinney SP, Lala A, et al. Coronavirus and cardiovascular disease, myocardial injury, and arrhythmia: JACC focus seminar. J Am Coll Cardiol 2020;76:2011-23.