Two-dimensional Speckle-Tracking and Four-dimensional Echocardiographic Evaluation of Cardiac Involvement in Post-COVID-19 patients: Comparison of Symptomatic and Asymptomatic Groups.
Kareem Muhammed Alaraby Hussein Sholkamy, Azza Abdel Moniem Farrag, Abdalla Amin Elagha, Fatema Eissa Qaddoura, Mohsen Salah Abdelazeem Mahmoud Nahla, Khalid Abdulraheem Al Faraidy, Noureldin Hamdan Samhoon Sahal, Salma Albahrani, Wefag Abdelazeem Mustafa Elsuni, Fathia Adel Abdo Samter
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Abstract
Context: Subclinical myocardial dysfunction may follow mild COVID-19, highlighting the importance of early detection.
Aims: To evaluate cardiac involvement in recently recovered COVID-19 patients using two-dimensional speckle-tracking echocardiography (2D-STE) and four-dimensional-transthoracic echocardiography (4D-TTE), comparing symptomatic and asymptomatic groups.
Settings and design: This study involves a prospective observational cohort study at a tertiary cardiac center.
Subjects and methods: Ninety-four adults (mean age 37 ± 7.5 years) post-COVID-19 recovery underwent echocardiographic evaluation at 1 and 3 months. Assessments included left and right ventricular (RV) function, myocardial strain using 2D STE, and left ventricular volumes and ejection fraction using 4D TTE.
Statistical analysis: Paired and independent t-tests were applied, with statistical significance set at P < 0.05.
Results: Statistically significant improvement was observed over time. Left ventricular end-diastolic volume decreased from 89.3 ml to 84.7 ml, left ventricular end-systolic volume from 31.9 ml to 29.4 ml, left ventricular ejection fraction (LVEF) increased from 64.8% to 66.0%, and left ventricular-global longitudinal strain improved from -23.8% to -24.7% (all P < 0.001). 4D-TTE confirmed parallel reductions in left ventricular volumes and an LVEF increase from 62.8% to 64.5% (P ≤ 0.002). RV functional parameters improved, RV end-systolic area (6.19 cm-5.71 cm), RV-fractional area change (52.1%-54.4%), and RV-longitudinal strain (-26.5% to -27.9%) (all P < 0.001). Symptomatic patients had lower LVEF at baseline (63.4% vs. 65.2%, P = 0.004) and follow-up (64.3% vs. 66.1%, P = 0.032); these findings should be interpreted cautiously due to the limited subgroup size.
Conclusions: Mild or asymptomatic COVID-19 infections may cause temporary cardiac dysfunction. 2D-STE and 4D-TTE are sensitive tools for early detecting subclinical myocardial involvement and guiding follow-up care.
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