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. 2024 Sep 25;6(12):1513-1520.
doi: 10.1016/j.cjco.2024.09.006. eCollection 2024 Dec.

Left Atrial Strain in Omicron-Type COVID-19 Patients

Sheizaf Gefen  1 , Aviel Shetrit  1 , Eihab Ghantous  1 , Aviram Hochstadt  1 , Lior Lupu  1 , Ariel Banai  1 , Erez Levi  1 , Yishay Szekely  1 , David Zahler  1 , Nadav Schellekes  2 , Tammy Jacoby  1 , Tamar Itach  1 , Philippe Taieb  1 , Lia Shidlansik  1 , Dana Viskin  1 , Amos Adler  3 , Ekaterina Levitsky  3 , Merav Ingbir  4 , Ofer Havakuk  1 , Shmuel Banai  1 , Yan Topilsky  1
Affiliations

Left Atrial Strain in Omicron-Type COVID-19 Patients

Sheizaf Gefen et al. CJC Open. .

Abstract
in English, French

Background: Information about left atrial (LA) 2-dimensional (2D) strain parameters in patients with the Omicron variant of COVID-19 is limited. The aim of this study is to evaluate LA strain (LAS) in COVID-19 patients with the Omicron variant and compare it to that of propensity-matched patients with the wild-type (WT) variant.

Methods: A total of 148 consecutive patients who were hospitalized with Omicron COVID-19 underwent an echocardiographic evaluation within the first day after hospital admission and were compared to propensity-matched patients (1:1) with the WT variant. LA 2D speckle tracking echocardiography parameters included the following: LAS, reservoir (LASr); LAS, conduit (LAScd); LAS, contraction (LASct); and LASr to the ratio between early mitral inflow velocity/mitral annular early diastolic velocity (E/e'). The values for the parameters that occurred during acute Omicron-type infection were compared with those found on historic examinations in 36 patients.

Results: Compared to the matched WT cohort, patients with acute Omicron-type infection had similar LASr (31.3% ± 13.3% vs 33.0% ± 14.2%), LAScd (-18.7% ± 9.8% vs -18.6% ± 10.8%), and LASct (-12.5% ± 8.6% vs -13.6% ± 8.2%) values (P > 0.2 for all), but a higher E/e' ratio (11.8 ± 6 vs 10.1 ± 7; P = 0.03). Surprisingly, LASr (31.9% ± 13.7% vs 22.6% ± 13.9%; P = 0.04) and LAScd (-18.7% ± 9.7% vs -10.7% ± 6.6%; P < 0.001) improved in patients during acute infection. LASr, LAScd, and LASr/(E/e') were significantly associated with an increased risk of either in-hospital mortality, need for mechanical ventilation, or the combined event.

Conclusions: In hospitalized patients with an Omicron COVID-19 infection, LAS parameters are similar to those of matched patients with WT variant and are associated with mortality and respiratory deterioration. These abnormalities were recorded previously in the 36 patients with historical echocardiograms, suggesting that they are related to background cardiac disease.

Contexte: L'information sur les paramètres de déformation bidimensionnelle (2D) de l'oreillette gauche (OG) chez les patients atteints du variant Omicron de la COVID-19 est limitée. Le but de cette étude est d'évaluer la déformation de l'oreillette gauche (DOG) chez les patients atteints de la COVID-19 avec le variant Omicron et de la comparer à celle de patients appariés selon la propension ayant le variant de type sauvage (WT).

Méthodes: Au total, 148 patients consécutifs, hospitalisés pour une COVID-19 avec variant Omicron ont subi une évaluation échocardiographique le premier jour de leur admission à l'hôpital et ont été comparés à des patients appariés selon la propension (1:1) avec la variante WT. Les paramètres de l'échocardiographie de suivi des marqueurs acoustiques en 2D de l'OG comprenaient les éléments d'évaluation de la DOG avec la fonction réservoir (DOGr); la fonction conduit (DOGcd); la fonction pompe/contraction (DOGct); ainsi que la DOGr au rapport entre la vitesse d’entrée mitrale précoce et la vitesse diastolique précoce annulaire mitrale (E/e'). Les valeurs des paramètres observées lors d'une infection aiguë de type Omicron ont été comparées à celles relevées lors d'examens antérieurs chez 36 patients.

Résultats: Par rapport à la cohorte WT appariée, les patients atteints d'une infection aiguë de type Omicron avaient des valeurs similaires de DOGr (31,3 % ± 13,3 % vs 33,0 % ± 14,2 %), DOGcd (-18,7 % ± 9,8 % vs -18,6 % ± 10,8 %) et DOGct (-12,5 % ± 8,6 % vs -13,6 % ± 8,2 %) (p > 0,2 pour tous), mais un rapport E/e' plus élevé (11,8 ± 6 vs 10,1 ± 7; p = 0.03). De façon surprenante, la fonction réservoir DOGr (31,9 % ± 13,7 % vs 22,6 % ± 13,9 %; p = 0.04) et la fonction conduit DOGcd (-18,7 % ± 9,7 % vs -10,7 % ± 6,6 %; p < 0,001) se sont améliorées chez les patients au cours d'une infection aiguë. Les paramètres DOGr, DOGcd et DOGr/(E/e') ont été significativement associés à un risque accru de mortalité hospitalière, de besoin de ventilation mécanique ou de l'événement combiné.

Conclusions: Chez les patients hospitalisés atteints de la COVID-19 avec une infection par Omicron, les paramètres de la DOG sont similaires à ceux des patients appariés avec le variant WT et sont associés à la mortalité et à la détérioration respiratoire. Ces anomalies ont été enregistrées précédemment chez les 36 patients ayant des échocardiogrammes antérieurs, ce qui suggère qu'elles sont liées à une maladie cardiaque sous-jacente.

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Figures

Figure 1
Figure 1
Comparison of 2-dimensional- speckle tracking echocardiography left atrial parameters during infection with Omicron, compared to those from the historic echocardiographic examinationss. Left atrial strain (LAS), reservoir (LASr), LAS, conduit (LAScd), and LAS contraction (LASct) are represented by blue box plots (before acute infection) and orange box plots (during acute infection). Note that LASr and LAScd improved during the period of acute infection, whereas no significant changes occurred for LASct, during the period of acute disease.
Figure 2
Figure 2
Comparison of 2-dimensional speckle tracking echocardiography left atrial parameters during infection with Omicron to those of the wild-type COVID-19 cohort. Left atrial strain (LAS), reservoir (LASr), LAS, conduit (LAScd), and LAS contraction (LASct) are represented by blue box plots (Omicron-type) and orange box plots (wild-type). Note that no significant differences occurred in LASr, LAScd, and LASct between the COVID-19 strains during the period of acute infection.
See this image and copyright information in PMC

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