Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study

Background: COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection. Methods: Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyz-able, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardio-graphic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function. Results: For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not signif-icantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a signif-icant reduction of LVEF at follow-up (74.3% +/- 3.1% vs 64.4% +/- 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% +/- 5.9% vs 49.3% +/- 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<-18%) at baseline had a significant reduction of LVLS at follow-up (-21.6% +/- 2.6% vs-20.3% +/- 4.0%, P = .006), while patients with impaired LVLS at base-line had a significant improvement at follow-up (-14.5% +/- 2.9% vs-16.7% +/- 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>-20%) at baseline had significant improvement at follow-up (-15.2% +/- 3.4% vs -17.4% +/- 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 +/- 0.7 cm vs 4.6 +/- 0.6 cm, P = .019). Conclusions: Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.

Automated summary

Following acute COVID-19 infection, patients may experience changes in cardiac function. Overall, there were no significant changes in left and right ventricular function during the follow-up period for patients recovering from COVID-19 infection. However, differences were observed based on the baseline function of the left ventricle and right ventricle, indicating potential recovery from acute myocardial injury. Patients with impaired baseline function tended to show improvement in cardiac function, while those with hyperdynamic left ventricle or normal right ventricle function tended to experience a decrease in function.