Left Ventricular Global Longitudinal Strain as a Parameter of Mild Myocardial Dysfunction in Athletes after COVID-19

Whether symptoms during COVID-19 contribute to impaired left ventricular (LV) function remains unclear. We determine LV global longitudinal strain (GLS) between athletes with a positive COVID-19 test (PCAt) and healthy control athletes (CON) and relate it to symptoms during COVID-19. GLS is determined in four-, two-, and three-chamber views and assessed offline by a blinded investigator in 88 PCAt (35% women) (training at least three times per week/>20 MET) and 52 CONs from the national or state squad (38% women) at a median of two months after COVID-19. The results show that the GLS is significantly lower (GLS 18.53 +/- 1.94% vs. 19.94 +/- 1.42%, p < 0.001) and diastolic function significantly reduces (E/A 1.54 +/- 0.52 vs. 1.66 +/- 0.43, p = 0.020; E/E' l5.74 +/- 1.74 vs. 5.22 +/- 1.36, rho = 0.024) in PCAt. There is no association between GLS and symptoms like resting or exertional dyspnea, palpitations, chest pain or increased resting heart rate. However, there is a trend toward a lower GLS in PCAt with subjectively perceived performance limitation (p = 0.054). A significantly lower GLS and diastolic function in PCAt compared with healthy peers may indicate mild myocardial dysfunction after COVID-19. However, the changes are within the normal range, so that clinical relevance is questionable. Further studies on the effect of lower GLS on performance parameters are necessary.

Automated summary

The relationship between symptoms and impaired left ventricular function during COVID-19 remains unclear. In this study, the global longitudinal strain (GLS) of athletes with a positive COVID-19 test (PCAt) was compared to healthy control athletes (CON). The results showed lower GLS and diastolic function in PCAt, indicating mild myocardial dysfunction after COVID-19. However, the clinical relevance of these changes is questionable and further research is needed.