Biventricular myocardial function in Covid-19 recovered patients assessed by speckle tracking echocardiography: a prospective cohort echocardiography study

Although severe acute respiratory syndrome coronavirus 2 causes respiratory disease, it may also lead to cardiovascular involvement with unknown long-term consequences. The aim of our study was to evaluate prospectively cardiac involvement in patients after the recovery from Covid-19, using two-dimensional speckle tracking echocardiography. 100 Covid-19 recovered patients with preserved left ventricular ejection fraction, were included, divided based upon clinical manifestation into two groups, those who were treated ambulant and those who were hospitalized. All patients underwent echocardiographic evaluation after their recovery. Although overall LV systolic function expressed by EF was normal, left ventricular global longitudinal strain (LVGLS) was significantly lower in Covid-19 recovered patients (33.28 +/- 9.4 days after diagnosis) compared to controls (- 18.47 +/- - 2.4 vs. - 21.07 +/- - 1.76% respectively, p < 0.0001). Epsilon specially the lateral wall longitudinal strain (LATLS) and posterior wall longitudinal strain (POSTLS) were significantly reduced in all patients compared to controls (- 17.77 +/- - 3.48 vs. - 20.97 +/- - 2.86%, p < 0.0001 and - 19.52 +/- - 5.3 vs. - 22.23 +/- - 2.65%, p = 0.01). right ventricular global longitudinal strain (RVGLS) was significantly diminished only in the hospitalized group of Covid-19 recovered patients, compared to controls (- 18.17 +/- - 3.32 vs. - 26.03 +/- - 4.55% respectively, p < 0.0001). LVGLS is affected in almost all individuals after Covid-19 infection independently of the infection severity, with LATLS being the most sensitive marker of LV impairment and with POSTLS to follow. RV shows impaired GLS in severely ill patients highlighting RVGLS as a helpful tool of prognosis. Recovered patients from Covid-19 infection have to be monitored for a long time, since the term long Covid disease might also include the cardiac function.

Automated summary

This study prospectively evaluated cardiac involvement in Covid-19 recovered patients using two-dimensional speckle tracking echocardiography, finding that left ventricular global longitudinal strain was significantly lower in patients compared to controls after recovery. Recovery patients should be monitored long-term for potential cardiac implications.