Connections between Diabetes Mellitus and Metabolic Syndrome and the Outcome of Cardiac Dysfunctions Diagnosed during the Recovery from COVID-19 in Patients without a Previous History of Cardiovascular Diseases

SIMPLE SUMMARY: In this original article, we aimed to describe the immense influence of an augmented metabolic risk profile, such as the case of type 2 diabetes mellitus, metabolic syndrome, and obesity, on the evolution of a SARS-CoV-2 virus infection, with a focus on the cardiovascular abnormalities encountered in post-acute COVID-19 syndrome. We demonstrated that during the recovery from COVID-19, the above-mentioned pathologies, associated with an increased inflammatory burden, favor the development of various cardiac alterations—which are diagnosable by transthoracic echocardiography—in previously healthy individuals. At the 3- and 6-month follow-up, we observed that the echocardiographic parameters characterizing the left and right ventricular function, as well as the increased pressure in the pulmonary artery, had improved, which was not the case for diastolic dysfunction (mostly of type 3). These cardiac pathologies, such as the altered systolic and diastolic functions and/or the presence of pulmonary hypertension, could explain—at least partially—the development of long COVID-19 syndrome. Therefore, besides the usual post-COVID-19 assessments, patients with an increased metabolic risk profile should be supplementarily evaluated by a cardiologist, including by a comprehensive echocardiography, both during the acute infection as well as in the recovery period. ABSTRACT: (1) Background: Throughout the COVID-19 pandemic, it became obvious that individuals suffering with obesity, diabetes mellitus (T2DM), and metabolic syndrome (MS) frequently developed persisting cardiovascular complications, which were partially able to explain the onset of the long-COVID-19 syndrome. (2) Methods: Our aim was to document, by transthoracic echocardiography (TTE), the presence of cardiac alterations in 112 patients suffering from post-acute COVID-19 syndrome and T2DM, MS, and/or obesity, in comparison to 91 individuals without metabolic dysfunctions (MD); (3) Results: in patients with MD, TTE borderline/abnormal left (LVF) and/or right ventricular function (RVF), alongside diastolic dysfunction (DD), were more frequently evidenced, when compared to controls (p ˂ 0.001). Statistically significant associations between TTE parameters and the number of factors defining MS, the triglyceride-glucose (TyG) index, the severity of the SARS-CoV-2 infection, and the number of persisting symptoms (p ˂ 0.001) were noted. Significant predictive values for the initial C-reactive protein and TyG index levels, both for the initial and the 6-month follow-up levels of these TTE abnormalities (p ˂ 0.001), were highlighted by means of a multivariate regression analysis. (4) Conclusions: in diabetic patients with MS and/or obesity with comorbid post-acute COVID-19 syndrome, a comprehensive TTE delineates various cardiovascular alterations, when compared with controls. After 6 months, LVF and RVF appeared to normalize, however, the DD—although somewhat improved—did persist in approximately a quarter of patients with MD, possibly due to chronic myocardial changes.