Subclinical myocardial dysfunction in patients recovered from COVID-19.

Italia, Leonardo; Ingallina, Giacomo; Napolano, Antonio; Boccellino, Antonio; Belli, Martina; Cannata, Francesco; Rolando, Marco; Ancona, Francesco; Melillo, Francesco; Stella, Stefano; Ripa, Marco; Scarpellini, Paolo; Tresoldi, Moreno; Ortalda, Alessandro; Righetti, Beatrice; De Cobelli, Francesco; Esposito, Antonio; Ciceri, Fabio; Castagna, Antonella; Rovere, Patrizia Querini; Fragasso, Gabriele; Agricola, Eustachio

BACKGROUND Myocardial injury (MI) can be detected during the acute phase of Coronavirus disease 19 (COVID-19) and is associated with a dismal prognosis. Recent imaging studies described the persistence of cardiac abnormalities after the recovery. The aim of the study was to investigate the spectrum of cardiac abnormalities at mid-term follow-up in patients recovered from COVID-19 using clinical assessment, laboratory tests, and imaging evaluation with comprehensive echocardiography. METHODS This is an observational, cross-sectional study assessing an unselected cohort of consecutive patients recovered from COVID-19. MI was defined by elevated plasma levels of high sensitive troponin T (hsTnT). At the follow-up, a complete examination including echocardiography was performed. RESULTS The 123 patients included were divided into two groups according to the presence of MI during hospitalization: group A (without MI) and group B (with MI). After a median of 85 days, group B patients were more frequently symptomatic for dyspnea and had significantly higher values of hsTnT and N-Terminal prohormone of Brain Natriuretic Peptide (NT-proBNP), compared to Group A. No differences between the two groups in left nor right ventricle dimension and ejection fraction were found. However, in group B a significant reduction of mean left ventricle global longitudinal strain was observed (-15.7±.7 vs -18.1± .3 in group A, p < 0.001), together with higher frequency of impaired diastolic function and higher values of pulmonary pressure. CONCLUSIONS In patients recovered from COVID-19, echocardiography with speckle-tracking analysis may be an useful imaging tool to identify subclinical myocardial dysfunction and potentially guide management strategies.