Recovery of Cardiac Function Following COVID-19 - ECHOVID-19: A Prospective Longitudinal Cohort Study

Lassen, Mats Christian Højbjerg; Skaarup, Kristoffer Grundtvig; Lind, Jannie Nørgaard; Alhakak, Alia Saed; Sengeløv, Morten; Nielsen, Anne Bjerg; Simonsen, Jakob Øystein; Johansen, Niklas Dyrby; Davidovski, Filip Søskov; Christensen, Jacob; Bundgaard, Henning; Hassager, Christian; Jabbari, Reza; Carlsen, Jørn; Kirk, Ole; Lindholm, Matias Greve; Kristiansen, Ole Peter; Nielsen, Olav Wendelboe; Ulrik, Charlotte Suppli; Sivapalan, Pradeesh; Gislason, Gunnar; Møgelvang, Rasmus; Jensen, Gorm Boje; Schnohr, Peter; Søgaard, Peter; Solomon, Scott D; Iversen, Kasper; Jensen, Jens Ulrik Staehr; Schou, Morten; Biering-Sørensen, Tor

AIMS: The degree of cardiovascular sequelae following COVID-19 remains unknown. The aim of this study was to investigate whether cardiac function recovers following COVID-19. METHODS AND RESULTS: A consecutive sample of patients hospitalized with COVID-19 were prospectively included in this longitudinal study. All patients underwent an echocardiographic examination during hospitalization and two months later. All participants were successfully matched 1:1 with COVID-19-free controls on age and sex. A total of 91 patients were included in this study (mean age 63±12 and 59% males). A median of 77 [72,92] days passed between the two examinations. Right ventricular (RV) function improved following resolution of COVID-19: tricuspid annular plane systolic excursion (TAPSE): (2.28cm±0.40 vs 2.11cm±0.38, P<0.001) and longitudinal strain of the right ventricle (RVLS) (25.3%±5.5 vs 19.9%±5.8, P<0001). In contrast, left ventricular (LV) systolic function assessed by global longitudinal strain (GLS) did not significantly improve (17.4±2.9 vs 17.6%±3.3, P=0.6). NT-proBNP decreased between the two examinations (177.6 (80.3,408,0) vs 1.7 (5.7,24.0), P<0.001). None of the participants had elevated troponins at follow-up compared to 18 (27.7%) during hospitalization. Recovered COVID-19 patients had significantly lower GLS (17.4%±2.9 vs 18.8%±2.9, P=0.001 & adjusted P=0.004), TAPSE (2.28cm±0.40 vs 2.67cm±0.44, P<0.001 & adjusted P<0.001), and RVLS (25.3%±5.5 vs 26.6%±5.8, P=0.50 & adjusted P<0.001) compared to matched controls. CONCLUSION: Acute COVID-19 affected negatively RV function and cardiac biomarkers but recovered following resolution of COVID-19. In contrast, the observed reduced LV function during acute COVID-19 did not improve post-COVID-19. Compared to the matched controls, both LV and RV function remained impaired.