Clinical Investigations
Ventricular Function After Acute COVID-19 Infection
Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study

https://doi.org/10.1016/j.echo.2021.10.015Get rights and content

Highlights

  • Little is known about long-term cardiac complications of COVID-19 infection.

  • We compare echocardiographic findings during hospitalization and follow-up.

  • No changes in population mean values for LV and RV parameters after COVID-19 occurred.

  • LV and RV function improve in patients with impaired baseline function.

  • LV and RV function decrease in patients with hyperdynamic LV or normal RV.

Background

COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection.

Methods

Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyzable, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardiographic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function.

Results

For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not significantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a significant reduction of LVEF at follow-up (74.3% ± 3.1% vs 64.4% ± 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% ± 5.9% vs 49.3% ± 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<−18%) at baseline had a significant reduction of LVLS at follow-up (−21.6% ± 2.6% vs −20.3% ± 4.0%, P = .006), while patients with impaired LVLS at baseline had a significant improvement at follow-up (−14.5% ± 2.9% vs −16.7% ± 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>−20%) at baseline had significant improvement at follow-up (−15.2% ± 3.4% vs −17.4% ± 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 ± 0.7 cm vs 4.6 ± 0.6 cm, P = .019).

Conclusions

Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.

Keywords

Echocardiography
WASE
COVID-19
Left ventricular function
Right ventricular function

Abbreviations

2CH
Two-chamber
4CH
Four-chamber
AI
Artificial intelligence
df
Degrees of freedom
ICU
Intensive care unit
LV
Left ventricular
LVEDV
Left ventricular end-diastolic volume
LVEF
Left ventricular ejection fraction
LVESV
Left ventricular end-systolic volume
LVLS
Left ventricular longitudinal strain
RV
Right ventricular, ventricle
RVBD
Right ventricle basal diameter
RVFWS
Right ventricular free-wall strain
RVGLS
Right ventricular global longitudinal strain
WASE
World Alliance Societies of Echocardiography

Cited by (0)

A full list of additional WASE-COVID investigators is provided after the conclusion.

Conflicts of Interest: G.M.W., and T.D. are employees of Ultromics. R.S. is a consultant for Ultromics. M.J.M. is on the advisory board and speaker's bureau for Bracco and Philips. F.M.A. received institutional (MedStar Health) research grants from TOMTEC, Ultromics, GE, and Caption Health and is on the nonpaid scientific advisory committee for Ultromics. R.M.L. is on the advisory board and speaker's bureau for Philips and the advisory board for Caption Health. All other authors have no conflicts of interest to disclose related to this work.

This work was supported by the American Society of Echocardiography Foundation, the University of Chicago, and MedStar Health with in-kind support from Ultromics and TOMTEC.

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