Echocardiographic Changes At Follow-up In Patients With Myocardial Dysfunction During Acute Coronavirus Disease 2019 (COVID-19) Infection

INTRODUCTION: COVID-19 infection has been associated with acute myocardial dysfunction. However, long-term effects of myocardial injury during COVID-19 infection are not well characterized. Novel speckle tracking echocardiography (STE) may lend further insights into COVID-19 myocardial dysfunction. METHODS: Patients hospitalized with acute COVID-19 infection from March 2020 to September 2021 who underwent STE and had evidence of myocardial dysfunction (defined as left ventricular ejection fraction (LVEF) less than 55% and/or global longitudinal strain (GLS) less negative than -18%) were enrolled in follow-up 3-12 months after hospitalization. Clinical and laboratory data were collected, and follow-up STE was performed, including LVEF, GLS, myocardial work index (MWI) and myocardial work efficiency (MWE) measurements. Statistical analysis was performed to determine risk factors for worsening myocardial dysfunction at follow-up. RESULTS: Twenty-four patients were enrolled at an average 239±102 days after the initial hospitalization echocardiogram: 13 (54%) male, 14 (58%) Black, and average age 56±14 years. Average duration of initial admission was 24±25 days; 14 patients (58%) were admitted to the intensive care unit. Ten (42%) patients had acute respiratory distress syndrome, 1 (4%) had ST-elevation myocardial infarction and 1 (4%) had cardiac arrest. Eleven (46%) patients required mechanical ventilation and 2 (8%) required extracorporeal membrane oxygenation. Five (21%) patients had elevated troponin on admission and average peak troponin was 1.35±3.83 ng/ml. Follow-up STE showed significant improvement in average GLS (-13.7±3.2% vs -16.0±3.7%, P=0.03). There were no significant changes in average LVEF (55.9±12.6% vs 55.5±8.8%, P=0.90), MWI (1519±425 vs 1681±412, P=0.24) and MWE (93±4 vs 92±4, P=0.65) at follow-up compared to during COVID-19 infection. Patients with lower LVEF at follow-up as compared to acute infection (n=11, 46%) were more likely to have had longer duration of symptoms prior to initial presentation (11±5 days vs 6±5 days, P=0.02) and higher peak erythrocyte sedimentation rate (94±30 mm/h vs 44±36 mm/h, P=0.007) compared to those with stable or improved LVEF. CONCLUSIONS: Approximately 8 months after COVID-19 infection, average GLS was significantly improved in patients with myocardial dysfunction during acute COVID-19 infection. Close follow-up is recommended for patients with evidence of myocardial injury during COVID-19 infection, especially those who present with prolonged symptoms and those with high inflammatory markers.