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

• Published in: International journal of cardiology. Heart & vasculature Vol. 32; p. 100719
• Main Authors: Shmueli, Hezzy, Shah, Maulin, Ebinger, Joseph E., Nguyen, Long-Co, Chernomordik, Fernando, Flint, Nir, Botting, Patrick, Siegel, Robert J.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2021; Elsevier
• Subjects: COVID-19; Echocardiography; Global longitudinal strain; Original Paper; CRP; T2DM; Echocardiography; HTN; TTE; RV; BNP; LVEF; ECG; SARS; Global longitudinal strain; LV; LV-GLS; VTI; TAPSE; LVOT; IL-6; COVID-19; LDH; LA; AV; ICU; CMRI; COPD; BNP, B-type natriuretic peptide; LVEF, left ventricular ejection fraction; HTN, hypertension; COPD, chronic obstructive pulmonary disease; VTI, velocity-time integral; AV, atrioventricular; LV-GLS, left ventricular global longitudinal strain; CMRI, cardiac magnetic resonance imaging; IL-6, interleukin-6; ECG, electrocardiogram; T2DM, type-2 diabetes mellitus; ICU, intensive care unit; LV, left ventricle; TTE, transthoracic echocardiogram; LA, left atrium; LDH, lactate dehydrogenase; LVOT, left ventricular outflow tract; SARS, severe acute respiratory syndrome; TAPSE, tricuspid annular plane systolic excursion; RV, right ventricle; COVID-19, coronavirus disease 2019; CRP, C-reactive protein
• DOI: 10.1016/j.ijcha.2021.100719
• ISSN: 2352-9067

•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. 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. 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). 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. 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.