Cardiac structural and functional changes in individuals with history of covid-19

Abstract
Introduction Coronavirus disease (COVID-19) was declared a global pandemic in 2019. It remains uncertain to what extent COVID-19 effects the cardiovascular system. The aim of the present study was to evaluate the effect of COVID-19 on cardiac structure and function in middle-aged and older people.

Methods A single centre, prospective, observational study recruited a total of 124 participants i.e., 84 with history of COVID-19 (COVID group) as confirmed by polymerase chain reaction and/or lateral flow test within the last 18 months and post-28 days of infection (mean age 60 ± 7 years, body mass index: 26.9 ± 4.2 kg/m2, 55% were female), and 40 participants without history of COVID-19 (non-COVID group; mean age 63 ± 7 years, body mass index: 26.5 ± 3.8 kg/m2, 63% were female). All participants were free of any underlying cardiac and or respiratory conditions in their medical history and prior to the study. Resting echocardiography was performed with speckle tracking (Vivid IQ, GE Healthcare, USA) to assess cardiac structure and function according to guidelines of the British Society of Echocardiography.

Results There was no significant difference between COVID and non-COVID groups in systolic and diastolic blood pressures (systolic: 134 ± 17 vs 131 ± 17 mmHg, p = 0.392; diastolic: 83 ± 8 vs 81 ± 10 mmHg, p = 0.156). Measures of cardiac systolic function such as left ventricular ejection fraction (LVEF) and stroke volume index (SVI) were not significantly different between COVID and non-COVID groups (LVEF: 58 ± 2.89 vs 59 ± 2.51 %, p = 0.565; and SVI: 41 ± 8 vs 38 ± 9 mL/m2, p = 0.083). There were also no significant differences between COVID and non-COVID groups in measures of cardiac diastolic function (mitral valve inflow E/A ratio: 1.00 ± 0.27 vs 1.00 ± 0.23, p = 0.543; tricuspid valve inflow E/A ratio: 1.22 ± 0.32 vs 1.32 ± 0.24, p = 0.142). No significant difference was seen in left ventricular filling pressures between COVID and non-COVID groups (E/e’: 7.80 ± 1.86 vs 7.72 ± 1.49, p = 0.724). However, participants in COVID group demonstrated significantly higher left ventricular mass index (69.4 ± 17.9 vs 62.1 ± 11.6 g/m2, p = 0.008), left atrial diameter (3.27 ± 0.7 vs 2.99 ± 0.43 cm, p = <0.001), relative wall thickness (0.38 ± 0.07 vs 0.36 ± 0.13, p = 0.049), and reduced left ventricular global longitudinal strain (18.3 ± 2.01 vs 19.3 ± 1.53 -%, p = 0.004), right ventricular fractional area change (39.4 ± 5.94 vs 42.2 ± 6.31 %, p = 0.012) and right ventricular lateral systolic velocity (RV S’: 0.14 ± 0.02 vs 0.13 ± 0.02 m/s, p = 0.032) compared to the non-COVID group.

Conclusion Findings from the present study suggest that individuals with history of COVID-19 may demonstrate structural and functional remodelling of the heart. These subclinical alterations in the heart should be closely monitored and preventive strategies timely deployed to avoid long-term deterioration in cardiac structure and function.