https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Ulm Sektion für Sport- und Rehabilitaionsmedizin Ulm, Deutschland; 2Institut für Epidemiologie und Medizinische Biometrie Ulm, Deutschland; 3Universitätsklinikum Heidelberg Innere Med. VII, Sportmedizin Heidelberg, Deutschland; 4Universitätsklinikum Tübingen Medizinische Klinik u. Poliklinik V/Sportmedizin Tübingen, Deutschland; 5Albert- Ludwigs-Universität Freiburg Rehabilitative und Präventive Sportmedizin Freiburg im Breisgau, Deutschland; 6Innere Medizin II Infektiologie Freiburg, Deutschland
Background and Aims
There is evidence that left ventricular global longitudinal strain (LV GLS) is reduced in subjects with persistent symptoms (PCS) compared to recovered subjects (CON) as a sign of possible long-term left myocardial involvement after SARS-CoV-2 infection, as we were able to show in the EPILOC study. The further investigations aimed to determine whether a reduction in LV GLS is associated with the occurrence of cardiopulmonary symptoms and with reduced exercise capacity.
Methods
Transthoracic echocardiogram was performed in 1,154 individuals (mean age 49±12 years, 760 women (66%)) who had a positive SARS-CoV-2 PCR test between October 1, 2020, and April 1, 2021 (mean 73±13 weeks after acute infection). LV GLS was determined in apical four-, two-, three-chamber views in 679 PCS and 475 CON and assessed offline by two blinded investigators using post-processing software. Cardiopulmonary exercise testing (CPET) was performed on a cycle ergometer with a linear ramp protocol and maximal respiratory oxygen uptake (VO2max/kg) was measured. The presence of persistent cardiopulmonary symptoms as well as chronic or rapid physical exhaustion was recorded using questionnaires.
Results
PCS showed significantly lower LV GLS compared to CON (-20.25% [95%CI, 0.36-3.68] vs. -20.73% [95%CI, 0.37-4.23], p=0.003). There was a significant positive association between LV GLS and the occurrence of rapid physical exhaustion (b=0.51, t (398) =1.97, p = 0.050) but no association between LV GLS and cardiopulmonary symptoms. Overall individuals (PCS and CON), a negative association was found for LV GLS (b=-0.38, t(712)=-2.93, p=0.004) and relative VO2max, indicating a higher VO2max in individuals with better LV GLS values.
Conclusions
Significantly reduced LV GLS in PCS compared to CON 1.5 years after SARS-CoV-2 infection may indicate long-term left myocardial involvement. Although cardiopulmonary symptoms are not associated with a reduction in LV GLS, physical performance and the subjective feeling of rapid physical exhaustion is associated with a myocardial component. Possible pathomechanisms should be investigated in further studies, while intervention studies should additionally examine whether cardiac function can be improved by training.