Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge

Aim    To study changes in clinical and echocardiographic parameters in patients after documented COVID-19 pneumonia at 3 months and one year following discharge from the hospital. 
Material and methods    The study included 116 patients who have had documented COVID-19 pneumonia. Patients underwent a comprehensive clinical evaluation at 3 months ± 2 weeks (visit 1) and at one year ± 3 weeks after discharge from the hospital (visit 2). Mean age of the patients was 49.0±14.4 years (from 19 to 84 years); 49.6 % were women. Parameters of global and segmentary longitudinal left ventricular (LV) myocardial strain were studied with the optimal quality of visualization during visit 1 in 99 patients and during visit 2 in 80 patients.
Results    During the follow-up period, the incidence rate of cardiovascular diseases (CVD) increased primarily due to development of arterial hypertension (AH) (58.6 vs. 64.7 %, р=0.039) and chronic heart failure (CHF) (35.3% vs. 40.5 %, р=0.031). Echocardiography (EchoCG) showed decreases in values of end-diastolic dimension and volume, LV end-systolic and stroke volumes (25.1±2.6 vs. 24.5±2.2 mm /m2, p<0.001; 49.3±11.3 vs. 46.9±9.9 ml /m2, p=0.008; 16.0±5.6 vs. 14.4±4.1 ml /m2, p=0.001; 36.7±12.8 vs. 30.8±8.1 ml /m2, p<0.001, respectively). LV external short-axis area (37.1 [36.6–42.0] vs. 38.7 [35.2–43.1] cm2, р=0.001) and LV myocardial mass index calculated with the area-length formula (70.0 [60.8–84.0] vs. 75.4 [68.2–84.9] g /m², р=0.024) increased. LV early diastolic filling velocity (76.7±17.9 vs. 72.3±16.0 cm /sec, р=0.001) and lateral and septal early diastolic mitral annular velocities decreased (12,10±3,9 vs. 11.5±4.1 cm /sec, р=0.004 and 9.9±3.3 vs. 8.6±3.0 cm /sec, р<0.001, respectively). The following parameters of LV global longitudinal (–20.3±2.2 vs. –19.4±2.7 %, р=0.001) and segmental strain were impaired: apical segments (anterior, from –22.3±5.0 to –20.8±5.2 %, р=0.006; inferior, from –24.6±4.9 to –22.7±4.6, р=0.003; lateral, from –22.7±4.5 to –20.4±4.8 %, р<0.001; septal, from –25.3±4.2 to –23.1±4.4 %, р<0.001; apical, from –23.7±4.1 to –21.8±4.1 %, р<0.001), mid-cavity (anteroseptal, from –21.1±3.3 to –20.4±4.1 %, р=0.039; inferior, from –21.0±2.7 to –20.0±2.9 %, р=0.039; lateral, from –18.4±3.7 to –17.6±4.4 %, р=0.021). RV basal and mid-cavity sphericity indexes increased (0.44±0.07 vs. 0.49±0.07 and 0.37±0.07 vs. 0.41±0.07, respectively, р<0.001 for both). A tendency for increased calculated pulmonary arterial systolic pressure (22.5±7.1 and 23.3±6.3 mm Hg, р=0.076) was observed. Right ventricular outflow tract velocity integral decreased (18.1±4.0 vs. 16.4±3.7 cm, р<0.001).
Conclusion    Patients after COVID-19 pneumonia one year after discharge from the hospital, compared to the follow-up data 3 months after the discharge, had an increased incidence of CVD, primarily due to the development of AH and CHF. EchoCG revealed changes in ventricular geometry associated with impairment of LV diastolic and systolic function evident as decreases in LV global longitudinal strain and LV myocardial apical and partially mid-cavity strain.

1.

2. National Institute for Health and Care Excellence (Great Britain). COVID-19 rapid guideline: managing the long-term effects of COVID-19. [NG188]. Av. at: http://www.ncbi.nlm.nih.gov/books/NBK567261/. 2020. ISBN 978-1-4731-3943-5

3. Morozov S.P., Protsenko D.N., Smetanina S.V., Andreychenko A.E., Ambrosi O.E., Balanyuk E.A. et al. Radiation diagnostics of coronavirus disease (COVID-19): organization, methodology, interpretation of results: Preprint No. CDT - 2020 - I. The series ‘Best practices of radiation and instrumental diagnostics’. Issue 65 - M.: GBUZ ‘NPCC DiT DZM’. - 60p. Av. at: https://niioz.ru/upload/iblock/19e/19e3ed390740eaa8ffe5f853f3d7e032.pdf.

4. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L 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. Journal of the American Society of Echocardiography. 2015;28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003

5. Rybakova M.K., Mitkov V.V., Baldin D.G. Echocardiography from M.K. Rybakova: Manual with DVD-ROM “Echocardiography from MK Rybakova”. Ed. 2nd. – M.: Publishing house Vidar-M;2018. - 600 p. ISBN 978-5- 88429-242-0

6. Otto CM, Pearlman AS. Textbook of clinical echocardiography. -Philadelphia: W.B. Saunders;1995. - 404 p. ISBN 978-0-7216-6634-1

7. Voigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/ Industry Task Force to standardize deformation imaging. European Heart Journal - Cardiovascular Imaging. 2015;16(1):1–11. DOI: 10.1093/ehjci/jeu184

8. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8–158. DOI: 10.18087/cardio.2475

9. Krinochkin D.V., Yaroslavskaya E.I., Shirokov N.E., Gultyaeva E.P., Krinochkina I.R., Korovina I.O. et al. Cardiovascular status and echocardiographic changes in survivors of COVID-19 pneumonia three months after hospital discharge. Russian Journal of Cardiology. 2021;26(9):35–41. DOI: 10.15829/1560-4071-2021-4656

10. Ramadan MS, Bertolino L, Zampino R, Durante-Mangoni E, Iossa D, Bertolino L et al. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review. Clinical Microbiology and Infection. 2021;27(9):1250–61. DOI: 10.1016/j.cmi.2021.06.015

11. Krishnamoorthy P, Croft LB, Ro R, Anastasius M, Zhao W, Giustino G et al. Biventricular strain by speckle tracking echocardiography in COVID-19: findings and possible prognostic implications. Future Cardiology. 2021;17(4):663–7. DOI: 10.2217/fca-2020-0100

12. Lassen MCH, Skaarup KG, Lind JN, Alhakak AS, Sengeløv M, Nielsen AB et al. Echocardiographic abnormalities and predictors of mortality in hospitalized COVID‐19 patients: the ECHOVID‐19 study. ESC Heart Failure. 2020;7(6):4189–97. DOI: 10.1002/ehf2.13044.

13. Baycan OF, Barman HA, Atici A, Tatlisu A, Bolen F, Ergen P et al. Evaluation of biventricular function in patients with COVID-19 using speckle tracking echocardiography. The International Journal of Cardiovascular Imaging. 2021;37(1):135–44. DOI: 10.1007/s10554-020-01968-5

14. Mahajan S, Kunal S, Shah B, Garg S, Palleda GM, Bansal A et al. Left ventricular global longitudinal strain in COVID‐19 recovered patients. Echocardiography. 2021;38(10):1722–30. DOI: 10.1111/echo.15199

15. Li X, Wang H, Zhao R, Wang T, Zhu Y, Qian Y et al. Elevated Extracellular Volume Fraction and Reduced Global Longitudinal Strains in Participants Recovered from COVID-19 without Clinical Cardiac Findings. Radiology. 2021;299(2): E230–40. DOI: 10.1148/radiol.2021203998

16. Чистякова М.В., Зайцев Д.Н., Говорин А.В., Медведева Н.А., Курохтина А.А. «Постковидный» синдром: морфо-функциональные изменения и нарушения ритма сердца. Российский кардиологический журнал. 2021;26(7):32-9. DOI: 10.15829/1560-4071-2021-4485

17. Jurcut R, Giusca S, La Gerche A, Vasile S, Ginghina C, Voigt J-U. The echocardiographic assessment of the right ventricle: what to do in 2010? European Journal of Echocardiography. 2010;11(2):81–96. DOI: 10.1093/ejechocard/jep234

18. Ярославская Е.И., Криночкин Д.В., Широков Н.Е., Криночкина И.Р., Гультяева Е.П., Гаранина В.Д. и др. Эхокардиографические показатели перенесших COVID-19 пневмонию через три месяца после выписки из стационара. Российский кардиологический журнал. 2021;26(8):65-75. DOI: 10.15829/1560-4071-2021-4620

19. Lassen MCH, Skaarup KG, Lind JN, Alhakak AS, Sengeløv M, Nielsen AB et al. Recovery of cardiac function following COVID‐19 – ECHOVID‐19: a prospective longitudinal cohort study. European Journal of Heart Failure. 2021;23(11):1903–12. DOI: 10.1002/ejhf.2347

20. Голухова Е.З., Сливнева И.В., Рыбка М.М., Мамалыга М.Л., Марапов Д.И., Ключников И.В. и др. Систолическая дисфункция правого желудочка как предиктор неблагоприятного исхода у пациентов с COVID-19. Кардиология. 2020;60(11):16–29. DOI: 10.18087/cardio.2020.11.n1303