Elsevier

IJC Heart & Vasculature

Volume 32, February 2021, 100719
IJC Heart & Vasculature

Left ventricular global longitudinal strain in identifying subclinical myocardial dysfunction among patients hospitalized with COVID-19

https://doi.org/10.1016/j.ijcha.2021.100719Get rights and content
Under a Creative Commons license
open access

Highlights

  • Acute cardiac injury (elevated Troponin) ranges from 8 to 28% in COVID-19 patients.

  • Standard overt cardiac dysfunction in TTE among COVID-19 patients is uncommon.

  • However, signs of subclinical myocardial dysfunction by GLS is prevalent.

Abstract

Background

The incidence of acute cardiac injury in COVID-19 patients is very often subclinical and can be detected by cardiac magnetic resonance imaging. The aim of this study was to assess if subclinical myocardial dysfunction could be identified using left ventricular global longitudinal strain (LV-GLS) in patients hospitalized with COVID-19.

Methods

We performed a search of COVID-19 patients admitted to our institution from January 1st, 2020 to June 8th, 2020, which revealed 589 patients (mean age = 66 ± 18, male = 56%). All available 60 transthoracic echocardiograms (TTE) were reviewed and off-line assessment of LV-GLS was performed in 40 studies that had sufficient quality images and the views required to calculate LV-GLS. We also analyzed electrocardiograms and laboratory findings including inflammatory markers, Troponin-I, and B-type natriuretic peptide (BNP).

Results

Of 589 patients admitted with COVID-19 during our study period, 60 (10.1%) underwent TTE during hospitalization. Findings consistent with overt myocardial involvement included reduced ejection fraction (23%), wall motion abnormalities (22%), low stroke volume (82%) and increased LV wall thickness (45%). LV-GLS analysis was available for 40 patients and was abnormal in 32 patients (80%). All patients with LV dysfunction had elevated cardiac enzymes and positive inflammatory biomarkers.

Conclusions

Subclinical myocardial dysfunction as measured via reduced LV-GLS is frequent, occurring in 80% of patients hospitalized with COVID-19, while prevalent LV function parameters such as reduced EF and wall motion abnormalities were less frequent findings. The mechanism of cardiac injury in COVID-19 infection is the subject of ongoing research.

Keywords

COVID-19
Echocardiography
Global longitudinal strain

Abbreviations

COVID-19
coronavirus disease 2019
SARS
severe acute respiratory syndrome
LV
left ventricle
TTE
transthoracic echocardiogram
LV-GLS
left ventricular global longitudinal strain
IL-6
interleukin-6
BNP
B-type natriuretic peptide
ICU
intensive care unit
CRP
C-reactive protein
LDH
lactate dehydrogenase
LVEF
left ventricular ejection fraction
LVOT
left ventricular outflow tract
VTI
velocity-time integral
RV
right ventricle
LA
left atrium
HTN
hypertension
COPD
chronic obstructive pulmonary disease
T2DM
type-2 diabetes mellitus
TAPSE
tricuspid annular plane systolic excursion
ECG
electrocardiogram
AV
atrioventricular
CMRI
cardiac magnetic resonance imaging

Cited by (0)