Signs of Lingering Cardiac Dysfunction After Severe COVID

Patients recovering from COVID-19 showed cardiac dysfunction on transthoracic echocardiography 3 to 4 months after hospital discharge, according to a Norwegian study.

Compared with matched controls, 204 COVID patients had worse right ventricular longitudinal strain (RVLS; adjusted estimated mean difference 1.5 percentage points, 95% CI 0.5-2.6), lower tricuspid annular plane systolic excursion (-0.10 cm, 95% CI -0.14 to -0.05), and reduced cardiac index (-0.26 L/min per m²; 95% CI -0.40 to -0.12), reported Charlotte Ingul, MD, PhD, of the Norwegian University of Science and Technology in Trondheim, and colleagues.

Reduced diastolic function was twice as likely among people post-COVID (30% vs 15% for controls; OR 2.4, 95% CI 1.4-4.2), with largely mild diastolic dysfunction, the researchers noted in the Journal of the American Heart Association.

On the other hand, the COVID group had slightly better left ventricular (LV) global longitudinal strain (LV GLS; -0.8 percentage points compared with controls, 95% CI -1.3 to -0.2), in line with other studies showing little LV dysfunction after COVID.

Ingul and colleagues also analyzed 24-hour ECGs from the patients with COVID, 27% of whom were found to have arrhythmias. It is unclear how these arrhythmias — mainly premature ventricular contractions (18%) and nonsustained ventricular tachycardia (5%) — related to COVID-19, they acknowledged.

This cohort study was based on the PROLUN project at six Norwegian centers and included 204 patients (mean age 58.5 years, 44% women) who volunteered for the study after being hospitalized with COVID-19 from February to June 2020.

Controls consisted of 204 participants from the fourth wave of the Trøndelag Health Study, matched by age, sex, BMI, systolic blood pressure, and comorbidities.

For the participating COVID patients, echocardiograms were performed a median of 102 days after discharge from the hospital.

Persistent dyspnea and fatigue were common among patients, and were not associated with cardiac dysfunction.

Those who required admission to the ICU had slightly worse RVLS than those not requiring intensive care, but had largely similar cardiac function otherwise.

Ingul’s team cautioned that RVLS and LV GLS could not be analyzed in 19% and 8% of patients, respectively, and that participants self-reported history of hypertension and cardiac disease.

A previous case-control study did not find that cardiac structure and function were impaired in patients 6 months after mild COVID-19 illness.