1Universitätsklinikum Ulm Sektion für Sport- und Rehabilitaionsmedizin Ulm, Deutschland; 2Universitätsklinikum Freiburg Institut für Bewegungs- und Arbeitsmedizin Freiburg im Breisgau, Deutschland; 3Universitätsklinikum Tübingen Medizinische Klinik u. Poliklinik V/Sportmedizin Tübingen, Deutschland; 4Universitätsklinikum Heidelberg Innere Med. VII, Sportmedizin Heidelberg, Deutschland; 5Universitätsklinikum Freiburg Klinik für Innere Medizin II Freiburg, Deutschland; 6Universitätsklinikum Heidelberg Klinik für Gastroenterologie, Infektionen, Vergiftungen Heidelberg, Deutschland; 7Universitätsklinikum Ulm Institut für Epidemiologie und Medizinische Biometrie Ulm, Deutschland
Background and Aims
Decreased left and right ventricular function has been observed in hospitalized patients in the setting of acute SARS-CoV-2 infection, but particularly the long-term cardiac sequelae have not been conclusively determined. The aim of this multi-center study was to investigate differences in cardiac structure and function by echocardiography including left ventricular global longitudinal strain (LV GLS) and right ventricular free wall longitudinal strain/four chambers longitudinal strain (RV FWSL/RV 4CLS) in subjects with suspected post-COVID syndrome (PCS) compared with recovered control subjects (CON).
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 infection) about 1.5 years after acute SARS-CoV-2 infection. LV GLS was determined in apical four-, two-, three-chamber views and RV FWSL /RV 4CLS in RV focused four-chamber view in 679 PCS and 475 CON. Strain values were assessed offline by two blinded investigators using post-processing software.
Results
PCS showed significantly lower LV GLS compared to CON (-20.21 ± 2.19% vs. -20.86 ± 2.33%, p < 0.003). RV strain values did not differ between PCS and CON (RV FWSL: -27.3 ± 4.7% vs. -27.6 ± 4.7%, p=0.659 and RV 4CLS: -23.2. ± 3.9% vs. -23.3 ± 3.8%, p=0.594). Differences remained when controlled for heart rate, systolic and diastolic blood pressure, age, sex, BMI and study centers. Echocardiographic parameters were within the normal clinical reference range.
Conclusions
Significant differences in LV GLS between PCS and CON 1.5 years after SARS-CoV-2 infection may indicate long-term left myocardial involvement whereas signs of right ventricular involvement were not present. However, the differences between the groups appear small and could also be explained by deconditioning due to PCS or pre-existing deconditioning as well as previously unknown subclinical findings or, most likely, more frequent presence of cardiovascular disease in the PCS group. Further investigations could focus on why only the left myocardium might be affected and whether there is evidence that persistent cardiac symptoms or rapid and chronic fatigue in PCS might be related to lower LV GLS.