Serial Left and Right Ventricular Strain Analysis in Patients Recovered from COVID-19

Highlights

• On average, no clinically significant differences were seen comparing pre- and post-COVID-19 TTEs.

• A new reduction of left or right ventricular strain after COVID-19 infection was uncommon.

• Reduction in strain was more common in patients with new symptoms following COVID-19.

Background

Strain analysis of transthoracic echocardiography (TTE) is a sensitive tool to detect myocardial dysfunction in those affected by COVID-19. Consideration of preexisting cardiovascular disease is important in detecting changes related to COVID-19. We sought to assess serial TTE changes in patients recovered from COVID-19 compared with baseline, pre-COVID-19 exams, with a focus on left and right ventricular longitudinal strain.

Methods

This retrospective review of serial TTEs in confirmed COVID-19 patients at Mayo Clinic sites included patients who had a TTE within 2 years prior to confirmed COVID-19 diagnosis, and the first available outpatient TTE after diagnosis was used as a comparison. Patients with interval cardiac surgery, procedure, or device placement (n = 9) were excluded. Biventricular strain was retrospectively performed on both echocardiograms.

Results

Of 259 individuals, ages 60 ± 16 years, 47% female, and 88% Caucasian, post-COVID-19 TTEs were performed a median of 55 days (interquartile range, 37-92) following diagnosis. No clinically significant TTE changes were noted, although left ventricular ejection fraction was higher (58% vs 57%, P = .049) and tricuspid annulus plane systolic excursion was lower (20 vs 21 mm, P = .046) following COVID-19. Baseline left ventricular global longitudinal strain (LV GLS) and right ventricular free wall strain (RV FWS) were normal (–19.6% and –25.8%, respectively) and similar following COVID-19 (–19.6% and –25.7%, P = .07 and .77, respectively). In the 74 inpatients, no significant change from baseline was seen for LV GLS (–19.4% vs –19.1%, P = .62), RV FWS (–25.5% vs –25.0%, P = .69), or left ventricular ejection fraction (57% vs 57%, P = .71). A significant worsening in strain occurred in 27 patients, 16 (6.8%) of the 237 with LV GLS and 14 (6.0%) of the 235 with RV FWS. Ten (20%) patients reporting new symptoms following COVID-19 had worsened strain, compared with 5 (7%) with persistent/progressive symptoms and 11 (9%) with no new symptoms (P = .04).

Conclusions

While patients with new symptoms following COVID-19 were more likely to have a worsening in absolute strain values, no clinically significant change in TTE parameters was evident in most patients following COVID-19 regardless of symptom status.