Cardiac performance in patients hospitalized with COVID-19: A 6-month follow-up study

Introduction Myocardial injury is frequently observed in patients hospitalized with Coronavirus disease 2019 (COVID-19) pneumonia. Different cardiac abnormalities have been reported during the acute COVID-19 phase but there is limited information on late cardiac sequelae in patients who have recovered from acute COVID-19 illness. Objective To document the presence and quantify the extent of myocardial functional alterations in patients hospitalized 6 months earlier for COVID-19 infection. Methods and results We conducted a prospective echocardiographic evaluation of 48 patients (58 ± 13 years, 69% male) hospitalized 6 ± 1 month earlier for a laboratory-confirmed and symptomatic COVID-19. Thirty-two (66.6%) had pre-existing cardiovascular risks factors (hypertension, T2DM or dyslipidemia) and three patients (6.2%) had a known prior myocardial infarction. Sixteen patients (33.3%) experienced myocardial injury during the index COVID-19 hospitalization as identified by a rise in cardiac troponin levels. Six months later, 60.4% of patients still reported clinical symptoms including exercise dyspnea for 56%. Echocardiographic measurements under resting conditions were not different between patients with vs. without myocardial injury during the acute COVID-19 phase. In contrast, low-level exercise (25 W for 3 minutes) induced a significant increase in the average E/e’ ratio (10.1 ± 4.3 vs. 7.3 ± 11.5, P = 0.01) and the systolic pulmonary artery pressure (33.4 ± 7.8 vs. 25.6 ± 5.3 mmHg, P = 0.02) in patients with myocardial injury during the acute COVID-19 phase. Sensitivity analyses showed that these alterations of left ventricular diastolic markers were observed regardless of cardiovascular disorders indicating SARS-CoV-2 infection as a primary cause. Conclusions Six months after the acute COVID-19 phase, significant cardiac diastolic abnormalities are observed in patients who experienced myocardial injury but not in patients without cardiac involvement.