Investigators Ask if COVID-19 Infection Is to Blame for Cardiac Dysfunction

Findings presented today during EuroEcho 2021, the annual echocardiography congress put on by the European Society of Cardiology, demonstrate a potential link between persistent dyspnea during physical activity in the year after recovery from COVID-19 infection and new-onset subclinical cardiac dysfunction.

Dyspnea, or shortness of breath, is recognized as a complication of long COVID. After excluding patients with previous cardiopulmonary disease, the aim of the present study was “to evaluate the presence of subclinical cardiac dysfunction, assessed by transthoracic echocardiography (TTE) in recovered COVID-19 patients, with or without dyspnea, after exclusion of previous cardiopulmonary disease.”

Results were presented during the session “More Insights From Imaging Into Outcome After COVID-19 Infection,” by Maria-Luiza Luchian, MD, University Hospital Brussels (UHB), Belgium.

The 66 patients included in the final analysis (mean age, 50 years; 67% men; 35% with dyspnea), none with a history of heart or lung disease, had COVID-19–related hospitalization between March and April 2020 at UHB. For this study, they underwent spirometry, a chest CT scan, and clinical evaluation at 6 months and spirometry, a chest CT scan, TTE, and clinical evaluation at 12 months to evaluate their lung function and possible sequelae of COVID-19. Imaging measures of heart function were compared against shortness of breath.

“The findings could help to explain why some patients with long COVID still experience breathlessness 1 year later and indicate that it might be linked to a decrease in heart performance,” said Luchian, in a statement announcing these results

The newer measures of global work index (GWI) and global constructive work (GCW) were employed during multivariable logistic regression to evaluate myocardial work, and overall, a potential link was seen between abnormal heart function and persistent dyspnea. This association was deemed significant, and it was seen after adjusting for age and gender:

• GCW: odds ratio (OR), 0.998 (95% CI, 0.996-1.000; P = .038)
• GWI: OR, 0.998 (95% CI, 0.996-1.000; P = .042)

In addition, the odds of having a normal respiratory pattern at 9 months were greatly reduced (OR, 0.195; 95% CI, 0.049-0.773; P = .020).

Myocardial work, another newer measure of cardiac dysfunction, was also employed to evaluate the patients, and it showed reduced efficiency in heart function that was associated with inflammation and mortality in the acute setting of COVID-19, Luchian noted, as well as persistent dyspnea. Myocarditis and ischemic injury were also seen in up to 50% of the patients at the 1- and 2-month marks after hospital discharge.

Residual mat glass opacities were also seen in 27.2% of the patients at 6 months and pulmonary fibrosis in 10.6% at 1 year following hospitalization, but neither correlated with persistent dyspnea.

“When looking in detail at heart function by cardiac ultrasound, we observed subtle abnormalities that might explain the continued breathlessness,” Luchian concluded. “Myocardial work could be a new echocardiographic tool for early identification of heart function abnormalities in patients with long COVID-19, who might need more frequent and long-term cardiac surveillance.”

She recommends that future studies of COVID-19 cover different variants of the disease, as well as long-term evolution of its cardiac consequences.

Reference

Luchian M-L. Persistent dyspnea 1 year after COVID -19 infection in apparently healthy subjects: a potential indicator of subclinical cardiac dysfunction. Presented at: EuroEcho 2021; December 9-11, 2021; virtual.