Cardiac imaging phenotype in patients with coronavirus disease 2019 (COVID-19): results of the cocarde study

Abstract

Biological cardiac injury related to the Severe Acute Respiratory Syndrome Coronavirus-2 infection has been associated with excess mortality. However, its functional impact remains unknown. The aim of our study was to explore the impact of biological cardiac injury on myocardial functions in patients with COVID-19. 31 patients with confirmed COVID-19 (CoV+) and 16 controls (CoV-) were prospectively included in this observational study. Demographic data, laboratory findings, comorbidities, treatments and myocardial function assessed by transthoracic echocardiography were collected and analysed in CoV+ with (TnT+) and without (TnT-) elevation of troponin T levels and compared with CoV-. Among CoV+, 13 (42%) exhibited myocardial injury. CoV+/TnT + patients were older, had lower diastolic arterial pressure and were more likely to have hypertension and chronic renal failure compared with CoV+/TnT-. The control group was comparable except for an absence of biological inflammatory syndrome. Left ventricular ejection fraction and global longitudinal strain were not different among the three groups. There was a trend of decreased myocardial work and increased peak systolic tricuspid annular velocity between the CoV- and CoV + patients, which became significant when comparing CoV- and CoV+/TnT+ (2167 ± 359 vs. 1774 ± 521%/mmHg, P = 0.047 and 14 ± 3 vs. 16 ± 3 cm/s, P = 0.037, respectively). There was a decrease of global work efficiency from CoV- (96 ± 2%) to CoV+/TnT- (94 ± 4%) and then CoV+/TnT+ (93 ± 3%, P = 0.042). In conclusion, biological myocardial injury in COVID 19 has low functional impact on left ventricular systolic function.

Keywords: COVID-19; Myocardial work.; SARS-CoV-2; Speckle tracking echocardiography; Strain.

Fig. 1

Bull’s-eye representation of longitudinal strain, myocardial work indices, and tricuspid annular S wave according to the presence of SARS-CoV-2 infection and/or biological cardiac injury. SARS-CoV-2: severe acute respiratory syndrome coronavirus-2

Fig. 2

Correlations between hs-Troponin T and left ventricular systolic function parameters. GLS global longitudinal strain; GMW global myocardial work; GWE global work efficiency; LVEF left ventricular ejection fraction; TAPSE tricuspid annular plane systolic excursion