USE OF STRAIN IMAGING TO DETECT SUBTLE MYOCARDIAL INVOLVEMENT IN POST
COVID-19 PATIENTS: AN INDIAN PERSPECTIVE
Abstract
Background: Global longitudinal strain (GLS) imaging by
echocardiography is an objective, well validated and cost-effective
modality for detecting subtle left ventricular function abnormalities.
Aim: We assessed the prevalence of subtle myocardial
dysfunction among patients clinically recovered from COVID-19 using
echocardiographic strain imaging. Results: Amongst 101 post
COVID-19 patients (76% males, mean age 55.45±11.14 years), prevalence
of diabetes mellitus, hypertension and dyslipidemia was comparable to 30
controls. The average GLS was significantly lesser in post
COVID patients (-16.21 ± 1.96 vs -18.49 ± 1.64, p = 0.004) and
significantly higher proportion of post COVID patients had
GLS > -18% (43% vs 22.58%, p =0.001) as compared to
controls. The RV free wall longitudinal strain
(RVFLS) was also lower in the patient group (22.35 ± 4.69 vs
24.19 ± 4.11, p =0.004) and 21.7% post COVID-19 patients
had impaired RV FWLS (> -20%) vs controls (6.6%).
Average GLS was significantly lesser in severe post COVID
patients (viz -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91, p
< 0.0001, respectively among severe, moderate and mild
COVID-19 patients. On performing regression analysis,
severity of COVID-19 (OR 7.762) was a significant
predictor of impaired GLS. Conclusion: Despite clinical
recovery and normal LVEF, post COVID-19 patients had significantly lower
LV GLS and RV FWLS. Those with severe COVID-19 infection, had worse LV
GLS and RV FWLS as compared to those with milder infection. This study
reiterates the importance of speckle tracking echocardiography as an
important imaging modality for detection of subclinical myocardial
dysfunction in the post COVID-19 recovered patients.