Condition of the Right Heart in Patients With COVID-19‑Associated Pneumonia: Follow-Up During Hospitalization

Aim      Dynamic assessment of the right heart in patients with COVID-19-associated pneumonia of different severity during regression of the systemic inflammatory response (SIR).

Material an methods    This single-center prospective study included 46 patients with the novel coronavirus infection COVID-19 and viral pneumonia according to chest multispiral computed tomography (CT). Laboratory and echocardiographic examinations of patients were performed.

Results Based on the results of evaluation with the Clinical Condition Scale (CCS-COVID), patients were divided into two groups: group A, patients with a score from 6 to 9 and group B, patients with a score from 10 to 14. The study results of both groups were evaluated twice: on day 10±2.5 from the onset of symptoms (groups A10 and B10, respectively) and again on day 17±1.8 (groups A17 and B17, respectively). Patients of group B10 had more pronounced SIR (C-reactive protein, 111.38±52.5 mg / l) and a larger volume of ground-glass opacity (38.3±9.6 %). At the first stage, higher values of right ventricular global longitudinal strain (RV GLS) were detected in group B10 compared to group A10 (23.2±4.8 % vs. 19.9±3.5 %, р=0.048). During the regression of SIR intensity and the positive dynamics of CT, lower values of Е / А were observed in group B17 (1.0 [0.98; 1.2]) vs. group А17 (1.4 [1.18; 1.5, p=0.015), and е’ / a’ in group B17 (0.66 [0.58; 0.85]) vs. 0.95 [0.79; 1.12] in group B17 (p=0.010). Е / А and е’ / a’ ratios were correlated with total lactate dehydrogenase fraction (r= –0.452 and p=0.006; r= –0.334 and p=0.050, respectively).

Conclusion      In patients with severe COVID-19-associated pneumonia during regression of SIR intensity, changes in the parameters that reflected RV diastolic dysfunction were observed.

1. Ammirati E, Wang DW. SARS-CoV-2 inflames the heart. The importance of awareness of myocardial injury in COVID-19 patients. International Journal of Cardiology. 2020;311:122–3. DOI: 10.1016/j.ijcard.2020.03.086

2. Dweck MR, Bularga A, Hahn RT, Bing R, Lee KK, Chapman AR и др. Global evaluation of echocardiography in patients with COVID-19. European Heart Journal Cardiovascular Imaging. 2020;21(9):949–58. DOI: 10.1093/ehjci/jeaa178

3. Poteshkina N.G., Krylova N.S., Karasev A.A., Nikitina T.A., Svanadze A.M., Beloglazova I.P. и др. Right heart condition in patients with COVID-19 pneumonia. Russian Journal of Cardiology. 2021;26(11):66–72. DOI: 10.15829/1560-4071-2021-4733

4. Carr E, Bendayan R, Bean D, Stammers M, Wang W, Zhang H и др. Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study. BMC Medicine. 2021;19(1):23. DOI: 10.1186/s12916-020-01893-3

5. Mareev V.Yu., Begrambekova Yu.L., Mareev Yu.V. How evaluate results of treatment in patients with COVID-19? Symptomatic Hospital and Outpatient Clinical Scale for COVID-19 (SHOCS-COVID). Kardiologiia. 2020;60(11):35–41. DOI: 10.18087/cardio.2020.11.n1439

6. Ministry of Health of Russian Federation. Temporary methodical recommendations. Prevention, diagnosis and treatment of new coronavirus infection (COVID-2019). Version 9 (26.10.2020). Av. at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/052/548/original/%D0%9C%D0%A0_COVID19_%28v.9%29.pdf?1603730062. 2020 г.

7. Zaidi A, Knight DS, Augustine DX, Harkness A, Oxborough D, Pearce K и др. Echocardiographic Assessment of the Right Heart in Adults: A Practical Guideline from the British Society of Echocardiography. Echo Research & Practice. 2020;7(1):G19–41. DOI: 10.1530/ERP-19-0051

8. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., Belenkov Yu.N., Konradi A.O., Lopatin Yu.M. и др. Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARSCoV-2)”. Data from 6-month follow-up. Russian Journal of Cardiology. 2021;26(10):86–98. DOI: 10.15829/1560-4071-2021-4708

9. Günay N, Demiröz Ö, Kahyaoğlu M, Başlılar Ş, Aydın M, Özer MÇ и др. The effect of moderate and severe COVID-19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis. The International Journal of Cardiovascular Imaging. 2021;37(6):1883–90. DOI: 10.1007/s10554-021-02171-w

10. Yaroslavskaya E.I., Krinochkin D.V., Shirokov N.E., Gorbatenko E.A., Krinochkina I.R., Gultyaeva E.P. и др. Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge. Kardiologiia. 2022;62(1):13–23. DOI: 10.18087/cardio.2022.1.n1859