Abnormal longitudinal strain reduction of basal left ventricular segments in patients recovered of COVID-19

A deeper look at long-term effects of COVID-19 on myocardial function in survivors with no prior heart diseases: a GRADE approach systematic review and meta-analysis

Objectives

The COVID-19 pandemic has challenged global health systems since December 2019, with the novel virus SARS-CoV-2 causing multi-systemic disease, including heart complications. While acute cardiac effects are well-known, long-term implications are understudied. This review hopes to fill a gap in the literature and provide valuable insights into the long-term cardiac consequences of the virus, which can inform future public health policies and clinical practices.

Methods

This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using ROBINS-I. The GRADE approach was employed to evaluate the level of certainty in the evidence for each outcome. A meta-analysis was conducted using the Comprehensive Meta-Analysis (CMA) software. In order to identify the underlying cause of high heterogeneity, a subgroup analysis was conducted. Sensitivity analysis was checked.

Results

Sixty-six studies were included in this review. Thirty-two of them enrolled in meta-analysis and the rest in qualitative synthesis. Most outcomes showed a moderate certainty of evidence according to the GRADE framework. Post-COVID individuals with no prior heart diseases showed significant changes in left ventricular (LV) and right ventricular (RV) echocardiographic indices compared to controls. These significant findings were seen in both post-acute and long-COVID survivors regardless of the severity of initial infection.

Conclusion

This review implies that individuals recovering from post-acute and long-term effects of COVID-19 may experience changes in myocardial function as a result of the novel coronavirus. These changes, along with cardiac symptoms, have been observed in patients without prior heart diseases or comorbidities.

Systematic Review Registration

PROSPERO, identifier (CRD42024481337).

Constrictive Pericarditis: An Update on Noninvasive Multimodal Diagnosis

Constrictive pericarditis (CP) is a rare condition that can affect the pericardium after every pericardial disease process and has been described even after SARS-CoV-2 infection or vaccine. In CP, the affected pericardium, usually the inner layer, is noncompliant, constraining the heart to a fixed maximum volume and impairing the diastolic function. This leads to several clinical features, that, however, can be pleomorphic. In its difficult diagnostic workup, noninvasive multimodal imaging plays a central role, providing important morphological and functional data, like the enhanced ventricular interdependence and the dissociation between intrathoracic and intracardiac pressures. An early and proper diagnosis is crucial to set an appropriate therapy, changing the prognosis of patients affected by CP. In this review, we cover in detail the main elements of each imaging technique, after a reminder of pathophysiology useful for understanding the diagnostic findings.

Effects of COVID-19 Infection in Healthy Subjects on Cardiac Function and Biomarkers of Oxygen Transport, Blood Coagulation and Inflammation

BACKGROUND

The manifestations, severity, and mortality of COVID-19 are considered to be associated with the changes in various hematological parameters and in immunity. Associations of immunoglobulin G antibodies against severe acute respiratory syndrome-linked coronavirus (IgG-SARS)-positive status with cardiac function and hematological and biochemical parameters in apparently health subjects are poorly understood.

METHODS

The present cross-sectional study included 307 healthy volunteers (24-69 years of age; 44.8 ± 8.6 years; 80.4% men) and was initiated in 2019 before the COVID-19 pandemic. COVID-19 episodes were confirmed by detection of IgG-SARS against SARS-CoV-2 S1 RBD to reveal 70 IgG-SARS-positive and 237 negative participants. Numerous ultrasound characteristics were assessed by echocardiography, and 15 hematological and biochemical parameters were assayed in the blood. Descriptive and comparative analysis was based on the IgG-SARS status of the participants.

RESULTS

The left ventricular mass index, mitral ratio of peak early to late diastolic filling velocity or flow velocity across the mitral valve, and deceleration time of early mitral inflow were decreased (p < 0.05) in IgG-SARS-positive participants versus those in IgG-SARS-negative participants according to multivariate logistic regression analysis. Erythrocyte sedimentation rate and platelet count were slightly increased, and blood hemoglobin was decreased in IgG-SARS-positive participants compared with those in IgG-SARS-negative participants.

CONCLUSIONS

LV filling, inflammation, blood coagulation, and hemoglobin appear to be influenced by COVID-19 infection in healthy participants. Our observations contribute to the definition of vulnerabilities in the apparently healthy subjects with long COVID-19. These vulnerabilities may be more severe in patients with certain chronic diseases.

Echocardiography in Coronavirus Disease 2019 Era: A Single Tool for Diagnosis and Prognosis

Coronavirus disease 2019 (COVID-19) is characterized by multi-organ involvement, including respiratory and cardiac events. Echocardiography is widely considered the first-choice tool for the evaluation of cardiac structures and function because of its reproducibility, feasibility, easy to use at bedside, and for good cost-effectiveness. The aim of our literature review is to define the utility of echocardiography in the prediction of prognosis and mortality in COVID-19 patients with mild to critical respiratory illness, with or without known cardiovascular disease. Moreover, we focused our attention on classical echocardiographic parameters and the use of speckle tracking to predict the evolution of respiratory involvement. Finally, we tried to explore the possible relationship between pulmonary disease and cardiac manifestations.