Key result
Impaired left atrial reservoir strain predicts persistent exertional dyspnea and exercise intolerance post-COVID-19.
Why the study?
While myocardial injury during active COVID-19 has an established pathological base, post-recovery myocardial injury remains obscured.
Does left atrial longitudinal strain analysis detect early cardiac dysfunction in previously healthy patients with long COVID-19 syndrome?
Case-Control (n=63)
No
Does left atrial longitudinal strain analysis detect early cardiac dysfunction in previously healthy patients with long COVID-19 syndrome?
Effect estimate: OR 0.72 (95% CI 0.59-0.896)
Absolute Event Rate: 22.7% vs 40%
p-value: p=0.003
Impaired left atrial strain parameters are significantly associated with exertional dyspnoea and exercise intolerance post-COVID-19, indicating early LV diastolic dysfunction.
LA strain impairment may signal early diastolic dysfunction in long COVID; hypothesis-generating and should not yet change practice.
It is known that during the active course of Coronavirus disease 2019 (COVID-19), myocardial injury has an established pathological base, while its myocardial injury post-recovery is still obscured.The aim of this study was to evaluate the longitudinal left atrial strain (LAS) using speckle tracking echocardiography (STE) in COVID-19-recovered patients who are previously healthy without confounder comorbidities to detect the potential cardiac dysfunction.200 patients were prospectively included and examined 4?12 weeks after recovery from COVID-19 infection. 137 participants with comorbidities or previous history of cardiopulmonary disease were excluded from the analysis. A total of 63 patients who fulfilled our inclusion criteria were recruited into two groups according to thepresence or absence of persistent dyspnoea and exercise intolerance. Clinical, laboratory & comprehensive echocardiographic examinations were done for all. We observed that 31.7% of the previously healthy individuals developed dyspnoea & exercise intolerance post-COVID-19 infection. There were significantly impaired LAS parameters in the symptomatic group (LA reservoir, contraction & conduit strain, 22.7%, -6.6% & -16.1% versus 40%, -12%, and ? 27% in the asymptomatic group with P < 0.000). Only LA reservoir strain and LA stiffness can independently predict the development of dyspnoea & exercise intolerance post-COVID-19 at cut-off values of 30% & 24.5% respectively with a sensitivity of 90% and a specificity of 91%, P < 0.001. These impaired LAS parameters could explain the developed symptoms post-COVID-19 recovery, even before disturbed conventional diastolic echocardiographic parameters.LAS parameters are significantly associated with the developed exertional dyspnoea & exercise intolerance post-COVID-19. LA reservoir strain & LA stiffness could provide a simple, easily available tool that points to early LV diastolic dysfunction and may direct the therapy in this subset of the population.
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ZeinElabdeen et al. (2023) conducted a case-control in Long COVID-19 syndrome (n=63). Symptomatic (persistent dyspnoea and exercise intolerance) vs. Asymptomatic was evaluated on Left atrial reservoir strain (OR 0.72, 95% CI 0.59-0.896, p=0.003). Impaired left atrial reservoir strain (22.7% vs 40%) independently predicted the development of persistent exertional dyspnoea and exercise intolerance in previously healthy patients post-COVID-19.
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