COVID-19 PNÖMONİSİ GEÇİRMİŞ HASTALARDA SOL VENTRİKÜL STRAİN DEĞERİNİN BÖLGESEL TUTULUMU

Abstract

Amaç: Kardiyovasküler tutulumu olan COVID-19 hastalarının, kardiyovasküler tutulumu olmayanlara göre daha kötü prognoza sahip olduğu gösterilmiştir. Bu çalışma, pnömonisi olan ve olmayan COVID-19 hastalarında taburculuk sonrası sol ventrikül (LV) global ve bölgesel strain değerinin bozulup bozulmadığını araştırmaktadır. Gereç ve Yöntem: Bu kesitsel çalışmaya, PCR testi ile tanı konulan ve polikliniğimize başvuran 78 hasta dahil edildi. Tüm hastalara ilk muayenelerinde iki boyutlu ekokardiyografi ve speckle tracking ekokardiyografi (STE) yapıldı. Hastalar pnömonisi olan ve olmayan olarak iki gruba ayrıldı ve sağlıklı kontrol grubu ile karşılaştırıldı. Bulgular: Çalışmaya toplam 123 kişi alındı (78 COVID-19 hastası, 45 sağlıklı kontrol). Hem kontrol grubunda hem de farklı ciddiyetteki COVID-19 hastalarında ilk ve takip hs-troponin-T değerleri benzerdi. Sol ventrikül ejeksiyon fraksiyonu (EF) tüm gruplarda benzerdi. Bununla birlikte, sağlıklı kontroller ve pnömonisi olmayan hastalara kıyasla pnömonisi olan hastalarda LV global longitudinal straini (GLS) anlamlı ölçüde daha düşüktü. Bölgesel strain analizi, pnömonisi olmayan hastalara ve kontrol grubuna kıyasla pnömonisi olan hastaların mid-anterior, mid-anteroseptal, apikal-inferior, apikal-lateral and apeks bölgelerinde önemli ölçüde daha düşük strain değerlerine sahip olduğunu göstermiştir. Sonuç: Pnömonisi olmayan hastalara ve sağlıklı kontrollere kıyasla pnömonisi olan COVID-19 hastalarında sol ventrikül global ve bölgesel strain önemli ölçüde bozulmuştur. Bu bulgu, pnömonisi olan COVID-19 hastalarının, gizli sol ventrikül tutulumunun tespiti için strain ekokardiyografi ile değerlendirilmesi gerektiğini göstermektedir.

Keywords

• COVID-19
• pnömoni
• sol ventrikül
• bölgesel strain

REGIONAL INVOLVEMENT IN LEFT VENTRICULAR STRAIN IN PATIENTS RECOVERED FROM COVID-19 PNEUMONIA

Abstract

Objective: COVID-19 patients with cardiovascular involvement have been shown to have a worse prognosis compared to those without cardiovascular compromise. This study aimed to investigate whether left ventricular (LV) global and regional strain is impaired in patients with COVID-19 with or without pneumonia after discharge. Materials and Methods: Seventy-eight consecutive COVID-19 patients diagnosed by PCR test were enrolled in this cross-sectional study during their first follow-up visit to an outpatient clinic. All patients underwent two-dimensional echocardiography and speckle tracking echocardiography (STE) at the first follow-up visit. The patients were divided into two groups with or without pneumonia, and they were compared with the healthy control group. Results: A total of 123 subjects were included in the study (78 with COVID-19 and 45 in the control group). Admission and follow-up hs-troponin-T concentrations were similar in both the control group and patients with varying severity of COVID-19. LV ejection fraction (EF) was similar in all groups. However, LV global longitudinal strain (GLS) was significantly lower in subjects with pneumonia compared to the control group and subjects without pneumonia. Regional strain analysis showed that subjects with pneumonia had significantly lower strain values at mid-anterior, mid-anteroseptal, apical-inferior, apical-lateral, and apex regions than subjects without pneumonia or the control group. Conclusion: LV GLS and the regional strain were significantly impaired in COVID-19 patients with pneumonia compared to those without pneumonia or in to control group. This finding indicates that COVID-19 subjects with pneumonia should undergo strain measurement to detect concealed LV involvement.

Keywords

• COVID-19
• pneumonia
• left ventricle
• regional strain

References

1. 1. Akhmerov A, Marban E. COVID-19 and the heart. Circ Res 2020;126(10):1443-55. [CrossRef] google scholar
2. 2. Zheng KI, Feng G, Liu WY, Targher G, Byrne CD, Zheng MH. Extrapulmonary complications of Covid-19: a multisystem disease? J Med Virol 2021;93(1):323-35. [CrossRef] google scholar
3. 3. Johnson KD, Harris C, Cain JK, Hummer C, Goyal H, Perisetti A. Pulmonary and extra-pulmonary clinical manifestations of COVID-19. Front Med (Lausanne) 2020;7:526. [CrossRef] google scholar
4. 4. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020;17(5):259-60. [CrossRef] google scholar
5. 5. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet Lancet 2020;395(10223):497-506. [CrossRef] google scholar
6. 6. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020;109(5):531-8. [CrossRef] google scholar
7. 7. Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur Heart J 2021;42(2):206. [CrossRef] google scholar
8. 8. Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shahet B al. ST-segment elevation in patients with Covid-19 - A case series N Engl J Med 2020;382(25):2478-80. [CrossRef] google scholar

9. 9. O Griffin D, Jensen A, Khan M, Chin J, Chin K, Saad J, et al. Pulmonary embolism and increased levels of d-dimer in patients with coronavirus disease. Emerg Infect Dis 2020;26(8):1941-3. [CrossRef] google scholar
10. 10. Shi S, Qin M, B S, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with Covid-19 in Wuhan, China. JAMA Cardiol 2020;5(7):802-10. [CrossRef] google scholar
11. 11. Narayanan A, Aurigemma GP, Chinali M, Hill JC, Meyer TE, Tighe DA. Cardiac mechanics in mild hypertensive heart disease: a speckle-strain imaging study. Circ Cardiovasc Imaging 2009;2(5):382-90. [CrossRef] google scholar
12. 12. Ng AC, Delgado V, Bertini M, van der Meer RW, Rijzewijk LJ, Shanks M, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol. 2009;104(10):1398-401. [CrossRef] google scholar
13. 13. Leung DY, Ng AC. Emerging clinical role of strain imaging in echocardiography. Heart Lung Circ 2010;19(3):161-74. [CrossRef] google scholar
14. 14. 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. Int J Cardiovasc Imaging 2021;37(1):135-44. [CrossRef] google scholar
15. 15. Doherty J, Kort S, Mehran R, Schoenhagen P, Soman P, Dehmer GJ et al. ACC/AATS/AHA/ASE/ASNC/HRS/ SCAI/SCCT/SCMR/STS 2019 Appropriate use criteria for multimodality imaging in the assessment of cardiac structure and function in nonvalvular heart disease: A report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2019;73(4):488-516. [CrossRef] google scholar
16. 16. Heinen A, Raupach A, Behmenburg F, Hölscher N, Flögel U, Kelm M et al. Echocardiographic analysis of cardiac function after infarction in mice: validation of single-plane long-axis view measurements and the bi-plane Simpson Method. Ultrasound Med Biol 2018;44(7):1544-55. [CrossRef] google scholar
17. 17. Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaumet M al. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 2004;17(10):1021-9. [CrossRef] google scholar
18. 18. Clark DE, Parikh A, Dendy JM, Diamond AB, George-Durrett K, Fish FA et al. Covid-19 myocardial pathology evaluation in athletes with cardiac magnetic resonance (COMPETE CMR). Circulation 2021;143(6):609-12. [CrossRef] google scholar
19. 19. Nucifora G, Schuijf J, Delgado V, Bertini M, Scholte A, Ng AC et al. Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease. Am Heart J 2010;159(1):148-57. [CrossRef] google scholar
20. 20. Voigt JU, Exner B, Schmiedehausen K, Huchzermeyer C, Reulbach U, Nixdorff U et al. Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 2003;107(16):2120-6. [CrossRef] google scholar