Key result
Positive diastolic stress test two years post-COVID pneumonia linked to ~21% lower left atrial reservoir strain.
Why the study?
The morphofunctional state of the heart and progression of HFpEF after COVID-19 pneumonia over 2 years was not well characterized.
Cohort (n=95)
Absolute Event Rate: 23.8% vs 30.1%
p-value: p=<0.001
Two years after COVID-19 pneumonia, patients without HFpEF showed recovery of contractile and diastolic functions, whereas those with HFpEF did not.
HFpEF echo changes post-COVID pneumonia need cautious interpretation; leaves open validation of DST within HFA-PEFF for prognosis.
Objective. To analyze morphofunctional state of the heart according to echocardiography data depending on heart failure with preserved ejection fraction (HFpEF) throughout 2 years after COVID-19 pneumonia. Material and methods. Among 380 patients in the Prospective Registry of Persons with COVID-19-Associated Pneumonia, we selected 95 patients in 3 months after COVID-19 pneumonia for diastolic stress test (DST) and instrumental confirmation of HFpEF according to the HFA-PEFF diagnostic algorithm. Mean comprised 42%. Mean age was 57.5±7.1 years. Patients with negative DST (at visit 2 — 2 years later) made up the 1st group (n=77), patients with positive DST — the 2nd group (n=18). We analyzed left and right ventricular longitudinal strain (LS). Results. Both groups were comparable in main clinical and functional parameters 3 months after COVID-19 pneumonia, with the exception of NYHA class of heart failure (1.3±0.5 and 1.6±0.7, respectively, p=0.035) and HFA-PEFF algorithm scores (2.8±0.9 and 3.6±1.2, respectively, p=0.004). There were differences in left atrial reservoir strain (LASr) at visit 1 (29.6% [26.8;33.4] and 25.6% [20.0;28.4], p=0.002) and visit 2 (30.1% [27.8;36.7] and 23.8% [20.0;28.8], p<0.001). There was increase of left ventricular annular velocity assessed by tissue Doppler imaging (9.0 [7.5; 10.5] cm/s at visit 1 and 10.0 [8.0; 11.0] cm/s at visit 2, p=0.001), basal (17.5±2.6 and 19.0±2.4%, respectively, p<0.001) and mid-ventricular longitudinal strain (19.0±2.1 and 19.8±2.2%, p=0.016) only in the 1st group. According to logistic regression, the complex of LASr (OR 0.848; 95% CI: 0.738—0.975; p=0.020) and TDI e’ lat (OR 0.666; 95% CI: 0.451—0.982; p=0.040) at visit 2 were independently associated with positive DST. In ROC analysis, sensitivity and specificity of left atrial stiffness index (LASI) with cutoff value 0.33 in predicting positive DST were 72.2 and 81.8%, respectively (AUC=0.820; p<0.001). Conclusion. In 2 years after COVID-19 pneumonia, contractile and diastolic functions recovered in patients without HFpEF.
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Широков et al. (2024) conducted a cohort in COVID-19 pneumonia (n=95). Positive diastolic stress test (HFpEF) vs. Negative diastolic stress test (no HFpEF) was evaluated on Left atrial reservoir strain (LASr) at 2 years (p=<0.001). Patients with a positive diastolic stress test 2 years after COVID-19 pneumonia had significantly lower left atrial reservoir strain compared to those with a negative test (23.8% vs 30.1%; p<0.001).
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