Key result
Prior COVID-19 PE linked to persistent subclinical RV dysfunction and reduced RV-FWLS at one year.
Why the study?
The study aimed to investigate the presence of subclinical cardiac dysfunction in recovered COVID-19 patients stratified by a previous diagnosis of pulmonary embolism complicating pneumonia.
Does a history of COVID-19-related pulmonary embolism cause persistent subclinical right ventricular dysfunction at one year in recovered COVID-19 patients?
Cohort (n=44)
Does a history of COVID-19-related pulmonary embolism cause persistent subclinical right ventricular dysfunction at one year in recovered COVID-19 patients?
Absolute Event Rate: -18.9% vs -24.6%
p-value: p=<0.001
Recovered COVID-19 patients with a history of pulmonary embolism exhibit persistent subclinical right ventricular dysfunction, detectable by impaired RV-GLS and RV-FWLS, one year after the acute phase.
May indicate subclinical dysfunction post-COVID with prior PE; hypothesis-generating and requires validation in prospective cohorts.
The aim of this study was to investigate the presence of subclinical cardiac dysfunction in recovered coronavirus disease 2019 (COVID-19) patients, who were stratified according to a previous diagnosis of pulmonary embolism (PE) as a complication of COVID-19 pneumonia. Out of 68 patients with SARS-CoV-2 pneumonia followed up for one year, 44 patients (mean age 58.4 ± 13.3, 70% males) without known cardiopulmonary disease were divided in two groups (PE+ and PE−, each comprising 22 patients) and underwent clinical and transthoracic echocardiographic examination, including right-ventricle global longitudinal strain (RV-GLS), and RV free wall longitudinal strain (RV-FWLS). While no significant differences were found in the left- or right-heart chambers’ dimensions between the two study groups, the PE+ patients showed a significant reduction in RV-GLS (−16.4 ± 2.9 vs. −21.6 ± 4.3%, p < 0.001) and RV-FWLS (−18.9 ± 4 vs. −24.6 ± 5.12%, p < 0.001) values compared to the PE- patients. According to the ROC-curve analysis, RV-FWLS < 21% was the best cut-off with which to predict PE diagnosis in patients after SARS-CoV-2 pneumonia (sensitivity 74%, specificity 89%, area under the curve = 0.819, p < 0.001). According to the multivariate logistic regression model, RV-FWLS < 21% was independently associated with PE (HR 34.96, 95% CI:3.24–377.09, p = 0.003) and obesity (HR 10.34, 95% CI:1.05–101.68, p = 0.045). In conclusion, in recovered COVID-19 patients with a history of PE+, there is a persistence of subclinical RV dysfunction one year after the acute phase of the disease, detectable by a significant impairment in RV-GLS and RV-FWLS. A reduction in RV-FWLS of lower than 21% is independently associated with COVID-related PE.
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Ilardi et al. (2023) conducted a cohort in Recovered COVID-19 (n=44). Previous pulmonary embolism (PE+) vs. No previous pulmonary embolism (PE-) was evaluated on Right ventricular free wall longitudinal strain (RV-FWLS) (p=<0.001). Previous COVID-19-related pulmonary embolism was associated with persistent subclinical right ventricular dysfunction at one year, with reduced RV-FWLS (-18.9% vs -24.6%; P<0.001).
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