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Journal of the American Society of Echocardiography

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Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study - 03/03/22

Doi : 10.1016/j.echo.2021.10.015 
Ilya Karagodin, MD a, Cristiane Carvalho Singulane, MD a, Tine Descamps, PhD b, Gary M. Woodward, PhD b, Mingxing Xie, MD, PhD, FASE c, Edwin S. Tucay, MD, FASE d, Rizwan Sarwar, MRCP b, e, Zuilma Y. Vasquez-Ortiz, MD, PhD f, Azin Alizadehasl, MD, FASE g, Mark J. Monaghan, PhD h, Bayardo A. Ordonez Salazar, MD i, Laurie Soulat-Dufour, MD j, Atoosa Mostafavi, MD k, Antonella Moreo, MD l, Rodolfo Citro, MD m, Akhil Narang, MD n, Chun Wu, MD, PhD c, Karima Addetia, MD, FASE a, Ana C. Tude Rodrigues, MD o, Roberto M. Lang, MD, FASE a, Federico M. Asch, MD, FASE p, ⁎
on behalf of the

WASE-COVID Investigators

Vince Ryan V. Munoz, MD, Rafael Porto De Marchi, MD, Sergio M. Alday-Ramirez, PhD, Consuelo Orihuela, MD, Anita Sadeghpour, MD FASE, Jonathan Breeze, MD, Amy Hoare, Carlos Ixcanparij Rosales, MD, Ariel Cohen, MD, Martina Milani, MD, Ilaria Trolese, RDCS, Oriana Belli, MD, Benedetta De Chiara, MD, Michele Bellino, MD, Giuseppe Iuliano, MD, Yun Yang

a University of Chicago, Chicago, Illinois 
b Ultromics, Oxford, United Kingdom 
c Union Hospital, Tongji Medical College of HUST, Wuhan, Peoples Republic of China 
d Philippine Heart Center, Quezon City, Philippines 
e Experimental Therapeutics, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom 
f Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Mexico 
g Rajaie Cardiovascular Medical and Research Center, Echocardiography Research Center, IUMS, Tehran, Iran 
h King's College Hospital, London, United Kingdom 
i Centro Medico Nacional 20 de Noviembre, ISSSTE, Ciudad de Mexico, Mexico 
j Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, France 
k Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran 
l De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy 
m University of Salerno, Salerno, Italy 
n Northwestern University, Chicago, Illinois 
o Radiology Institute of the University of Sao Paulo Medical School, São Paulo, Brazil 
p MedStar Health Research Institute, Washington, DC 

∗Reprint requests: Federico M. Asch, MD, FASE, 100 Irving Street, NW, Suite EB 5123, Washington, DC 20010.100 Irving Street, NWSuite EB 5123WashingtonDC20010
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Abstract

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.

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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.

Le texte complet de cet article est disponible en PDF.

Keywords : Echocardiography, WASE, COVID-19, Left ventricular function, Right ventricular function

Abbreviations : 2CH, 4CH, AI, df, ICU, LV, LVEDV, LVEF, LVESV, LVLS, RV, RVBD, RVFWS, RVGLS, WASE


Plan


 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.


© 2021  American Society of Echocardiography. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 35 - N° 3

P. 295-304 - mars 2022 Retour au numéro
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