Volume 04 Issue 06-2024
40
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
06
P
AGES
:
40-48
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
A wide range of cardiac effects are observed during the acute phase of COVID-19. Interestingly, troponin levels are
raised in 8
–
28% of instances, while systolic myocardial dysfunction symptoms are not always evident. Subclinical
myocardial dysfunction is more common and is commonly defined as a decrease in the left ventricle's global
longitudinal strain (LV GLS). Up to 80% of individuals exhibit this alteration while they are in the hospital. LV GLS is a
crucial component in risk assessment for follow-up care and a strong independent predictor of in-hospital mortality.
The first results on the long-term cardiovascular effects of COVID-19 one year after hospitalization are presented in
this study. One year after discharge, we found that patients with COVID-19 pneumonia had a negative trend in LV GLS
and deformation metrics in the apical and certain middle segments of the LV myocardium, as compared to data
collected three months after discharge. The purpose of the study is to look at the prevalence and clinical significance
of long-term heart injury following COVID-19. In order to do this, we examined patient data and categorized patients
a year following hospital discharge according to their LV GLS values. This method aids in comprehending the clinical
ramifications of long-term cardiac injury after COVID-19.
KEYWORDS
To compare clinical and echocardiographic parameters in patients with proven COVID-19 pneumonia, depending on
the magnitude of global LV longitudinal strain (LV GLS) one year after discharge.
INTRODUCTION
Research Article
CARDIAC ULTRASOUND ALTERATIONS IN INDIVIDUALS WITH
PNEUMONIA RELATED TO COVID-19 INFECTION
Submission Date:
June 05, 2024,
Accepted Date:
June 10, 2024,
Published Date:
June 15, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue06-07
A.T. Ahmedov
Bukhara State Medical Institute named after Abu Ali ibn Sino, Republic of Uzbekistan, Bukhara, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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(ISSN
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VOLUME
04
ISSUE
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:
40-48
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1121105677
Publisher:
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Material and research methods: The recruitment of
patients was carried out from September 2021 to
February 2022. All examined gave written informed
consent to participate. Inclusion criteria: documented
diagnosis
of
COVID-19-associated
pneumonia,
willingness of the patient to participate in observation.
Exclusion criteria: chronic diseases in the acute stage,
a history of oncological diseases lasting less than 5
years, tuberculosis and other diseases accompanied by
pneumofibrosis, HIV, hemodynamically significant
heart defects, chronic hepatitis. Exclusion criteria:
unsatisfactory
imaging
on
echocardiography
(EchoCG), dilated, restrictive and hypertrophic
cardiomyopathy, pregnancy detected during the
observation period, oncological diseases, refusal to
participate.
58 patients who had COVID-19 pneumonia were
examined after a year ± 2 weeks. after discharge, the
mean age was 53.0 ± 16.7 years (from 18 to 84 years);
56.8% of them are men. The parameters of global and
segmental longitudinal myocardial deformity of the
left ventricle were studied in all examined patients with
optimal visualization quality in echocardiography
(EchoCG). Patients were divided into groups
depending on the LV GLS value: group 1 - with normal
LV GLS (< -20%) - 26 people, group 2 - with depressed LV
GLS (≥
-20%) - 32 people. The groups did not differ in age
(p = 0.145), severity of lung injury during hospitalization
(p = 0.691), duration of hospitalization (p = 0.626) and
frequency of stay in intensive care units (ICU) (p =
0.420).
Hospitalization data are obtained from extracts from
case histories. The severity of lung injury was assessed
in accordance with current recommendations [4], and
the maximum volume of lung injury was analyzed.
According to CT data, during hospitalization, 16 (27.9%)
patients had mild lesions, 20 (34.5%) had moderate
lesions, 17 (29.3%) had severe lesions, and 5 (8.6%) -
critical. 9 (15.5%) patients underwent treatment in
intensive care units (ICU) (Table 1).
Table 1.
Comparison of clinical data of hospitalization in patients with COVID-19-associated pneumonia
Parameters
Group with normal LV
GLS (≤
-20%) n=26
Group with LV GLS
disorders (≥
-20%) n=32
p
Duration of
hospitalization
days
13.6±3.7
17.2±4.3
0.634
Mild pneumonia
n (%)
5 (19.2)
11 (34.4)
0.308
Moderate
pneumonia
n (%)
9 (34.6)
11 (34.4)
0.834
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Severe
n (%)
8 (30.7)
7 (21.9.3)
0.413
Critical pneumonia
n (%)
8 (30.7)
9 (28.1)
0.873
ICU admission
n (%)
4 (14.7)
5 (15.6)
0.486
One year following their release, every patient got a CT
scan of the lungs and an echocardiogram utilizing the
state-of-the-art Vivid S70 ultrasonic diagnostic
equipment. Using TomTec software, EchoCG data
were examined on an IntelliSpace Cardiovascular
workstation (Philips, USA). Taking into consideration
gender variations and indexation to div surface area,
the linear dimensions of the cavities and wall thickness
of the heart, chamber volumes, and ventricular systolic
function were evaluated in compliance with the
guidelines [5].
Using the C. Otto et al. approach, the peak systolic
pressure in the pulmonary artery (pSPPA), the pressure
in the right atrium, and the peak pressure gradient of
tricuspid regurgitation are determined [6, 7]. All of the
patients who were examined had their global and
segmental longitudinal myocardial abnormality of the
left ventricle checked with the best possible
visualization quality. AFI (Automatic Functional
Imaging) mode was used to evaluate LV longitudinal
strain indicators [5, 8]. The lower limit of normal was
defined as the global longitudinal strain (LV GLS) value
greater than
–
20% [5]. There were 35 individuals in
group 1 with normal LV GLS (< -20%) and 45 individuals
in group 2 with impaired LV GLS (≥
-20%). The results of
the examination were entered into the electronic
database. The groups did not differ in age, severity of
lung damage during hospitalization.
Statistical analysis was performed using the SPSS 21
software package (SPSS Inc., Chicago, IL, USA) and
STATISTICA 12.0. The normality of the distribution of
quantitative indicators was checked by the
Kolmogorov-Smirnov criterion. Normally distributed
quantitative indicators were represented by the mean
and standard deviation (M ± SD), in the case of a non-
normal distribution, by the median (Me) and the
interquartile range [Q1
–
Q3]. Dichotomous categorical
indicators were described by absolute (n) and relative
(in %) frequencies of occurrence. Identification of
statistically significant intergroup differences in
indicators was carried out for normally distributed
quantitative indicators using Student's t-test for
independent groups, in the absence of normality -
using the Mann-
Whitney test. Pearson's χ2 test was
used to identify statistically significant differences
between categorical indicators. The critical level of
significance was p = 0.05.
Results: in contrast to group 1, the majority of patients
in group 2 were represented by men, the div surface
area (BSA) in this group was larger (Table 2).
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Table 2.
Comparison of clinical characteristics of patients with COVID-19-associated pneumonia
Parameters
Group with normal
LV GLS (≤-20%)
n=26
Group with LV GLS
disorders (≥-20%) n=32
p
Age
years
50.9 ± 12.9
46.1 ± 15.9
0.148
Male
n(%)
10 (28.6)
32 (71.1)
<0.001
Height
cm
166.3 ± 7.8
171.3 ± 17.7
0.003
Weight
kg
75.8 ± 13.1
87.8 ± 18.6
0.002
BMI
kg/m2
27.42 ± 4.65
28.79±5.03
0.873
div surface area
m2
1.8±0.2
2.0±0.2
0.486
Age, div mass index, incidence of obesity, and
cardiovascular disease did not differ between the
groups. The incidence, composition, and length of
arterial hypertension (AH), chronic heart failure (CHF),
frequency of cardiac rhythm abnormalities, and
glycemic profile did not differ significantly either.
Group 2 had a higher diagnosis rate of coronary heart
disease (CHD), including when combined with AH. The
majority of patients in both groups showed resolution
of their pneumonia symptoms based on CT data;
however, the statistical significance of the differences
in this sign between the groups was not demonstrated.
There was a propensity for the left ventricle's posterior
wall to be thinner in group 2. This tendency accelerated
after group 2's LV end-diastolic size, length, and stroke
volume were all reduced, along with the cardiac index,
following indexing to BSA. LV ejection fraction (EF),
type of geometry, and myocardial mass did not differ
significantly between groups. At this point in the trial,
neither a decrease in left ventricular ejection fraction
nor second-degree or higher mitral regurgitation were
present in the patients. Group 2 was characterized by a
smaller volume of LA emptying, a lower rate of FC MK
e', and a smaller integral of the linear flow velocity in
the LV outflow tract.
Significant intergroup differences in the structural and
functional parameters of the right ventricle (RV) were
found when evaluating the right heart (Table 4).
Specifically, group 2's RV area, transverse dimensions,
and sphericity indices were larger, and the fraction of
changes in the RV's area and the tricuspid ring's speed
S
ʹ
was below average. Long-term following the
disease, there was a 57.5% frequency of reduction in
the overall longitudinal distortion of the left ventricle.
There was a significant difference in the mean LV GLS
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between groups 1 and 2 (-17.6 ± 1.9 vs.
–
21.8 ± 1.2%; p <
0.001).
Discussion: An analysis of the right heart in group 2
showed that the pancreas differed structurally from
group 1 in terms of area, transverse dimensions, and
sphericity indices. Group 2 had poorer pancreatic
systolic function indicators, as evidenced by a
decreased pancreatic percentage of change area and a
slower-than-average tricuspid ring speed. The second
group exhibited inferior LV diastolic function
indicators, as demonstrated by a reduced left
ventricular emptying volume and a slower-moving
fibrous ring of the mitral valve e'. In addition, group 2's
integral of the linear flow rate
—
which represents the
LVOT's pumping function
—
was likewise smaller than
group 1's. Despite the fact that in this group the indices
of end-diastolic size (EDS) and LV length were lower,
significant differences in EF We didn't receive the LJ.
Magnetic resonance imaging (MRI) indicates that in
convalescents recovering from COVID-19, the
frequency of a decrease in the index of total
longitudinal deformity increases from 2% prior to three
months after the conclusion of the disease to 30%
during the course of three to six months. [9]. S.
Mahajan et al. reported comparable results using
transthoracic echocardiography 1
–
1.5 months after
discharge: 29.9% showed a decrease in LV GLS, with a
mean value of 19.7 ± 4.6%. [10]. We found that the
frequency of LV GLS declines in the long-term period
following the disease was 57.5%, which is much higher
than the results reported by S. Mahajan et al. and the
frequency of LV GLS deterioration during MRI [9].
However, it should be noted that such a comparison is
rather rough - and due to the low comparability of the
clinical characteristics of patients (not all observed by
S. Mahajan et al. had a symptomatic course of COVID-
19.
In our patients, the mean value of LV GLS after three
months of discharge was -20.3 ± 2.2% (total group
before separation), and in terms of dynamics, it
deteriorated significantly in a year compared to the
survey data three months later (
–
20.3 ± 2.2 vs.
–
19.4 ±
2.7%; p = 0.001) [3]. Despite the fact that Chinese
patients are older (59 ± 13 years) and stay in the ICU
more frequently (18.9%), the value of LV GLS after three
months of discharge in the observation of Chinese
colleagues of 46 patients who underwent COVID-19
was
–
26.6 ± 4.4% [11], which is better than that obtained
by us. A contribution to the differences in the results of
our studies could be made by the difference in vendors
[12] - colleagues used the Philips Medical Systems,
Andover, MA, USA system.
Prospective follow-up of 58 patients in the COVID-19
cohort When comparing MCH Lassen et al.'s findings
two months following hospitalization to hospital data,
LV GLS did not significantly improve (
–
17.4 ± 2.9 vs.
–
17.6 ± 3.3%; p = 0.6) [13]. This is lower than the values
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we found, which might be because the Danish patients
were somewhat older
—
62.5 ± 12.1 years
—
than ours.
When comparing hospitalization data with a single
center follow-up of 40 patients in the Netherlands FMA
van den Heuvel et al. within 4 months of release from
the hospital, a trend toward an increase in LV GLS was
observed (-18.5 versus -19.1%; p = 0.07). The
investigated cohort was older than our patients, but
had less comorbidities, which could account for the
positive dynamics [14]. Nevertheless, the results that
colleagues obtained likewise fall short of typical norms.
The lack of a unified approach to the formation of
study design is generally highlighted when analyzing
literature data on the topic of myocardial deformation
in the recovery period following COVID-19. This
naturally results in heterogeneity of the examined
contingent and makes it difficult to compare the
findings of different studies. But it's clear that
individuals who show a decline in LV GLS with intact LV
EF even a year after pneumonia need close observation
to avoid or promptly identify subsequent episodes of
heart failure, LV dysfunction, or arrhythmia.
The data show that additional research is required to
determine the cardiovascular status of individuals who
have recovered from COVID-19 pneumonia. This
research should involve collecting more data,
performing a subgroup analysis to identify predictors
of violations of the myocardium's deformation
properties, accounting for the treatment administered
during the acute phase of the illness, the impact of
concurrent cardiovascular diseases, etc.
CONCLUSIONS
One year after experiencing COVID-19 pneumonia,
58.6% of patients, who initially had normal left
ventricular ejection fraction (LV EF), showed reduced
global longitudinal strain of the left ventricle (LV GLS).
In the group with impaired LV GLS, there was a higher
prevalence of men. Additionally, these patients more
frequently presented with ischemic heart disease (IHD)
alongside hypertension. Furthermore, indicators of left
ventricular diastolic function were notably poorer in
this group compared to those with normal LV GLS.
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