Two-dimensional Speckle-Tracking and Four-dimensional Echocardiographic Evaluation of Cardiac Involvement in Post-COVID-19 patients: Comparison of Symptomatic and Asymptomatic Groups

Context: Subclinical myocardial dysfunction may follow mild COVID-19, highlighting the importance of early detection. Aims: To evaluate cardiac involvement in recently recovered COVID-19 patients using two-dimensional speckle-tracking echocardiography (2D-STE) and four-dimensional-transthoracic echocardiography (4D-TTE), comparing symptomatic and asymptomatic groups. Settings and Design: This study involves a prospective observational cohort study at a tertiary cardiac center. Subjects and Methods: Ninety-four adults (mean age 37 ± 7.5 years) post-COVID-19 recovery underwent echocardiographic evaluation at 1 and 3 months. Assessments included left and right ventricular (RV) function, myocardial strain using 2D STE, and left ventricular volumes and ejection fraction using 4D TTE. Statistical Analysis: Paired and independent t -tests were applied, with statistical significance set at P < 0.05. Results: Statistically significant improvement was observed over time. Left ventricular end-diastolic volume decreased from 89.3 ml to 84.7 ml, left ventricular end-systolic volume from 31.9 ml to 29.4 ml, left ventricular ejection fraction (LVEF) increased from 64.8% to 66.0%, and left ventricular-global longitudinal strain improved from −23.8% to −24.7% (all P < 0.001). 4D-TTE confirmed parallel reductions in left ventricular volumes and an LVEF increase from 62.8% to 64.5% ( P ≤ 0.002). RV functional parameters improved, RV end-systolic area (6.19 cm−5.71 cm), RV-fractional area change (52.1%–54.4%), and RV-longitudinal strain (−26.5% to −27.9%) (all P < 0.001). Symptomatic patients had lower LVEF at baseline (63.4% vs. 65.2%, P = 0.004) and follow-up (64.3% vs. 66.1%, P = 0.032); these findings should be interpreted cautiously due to the limited subgroup size. Conclusions: Mild or asymptomatic COVID-19 infections may cause temporary cardiac dysfunction. 2D-STE and 4D-TTE are sensitive tools for early detecting subclinical myocardial involvement and guiding follow-up care.