Follow-up study of the cardiac manifestations of multiethnic patients hospitalised with COVID-19

PURPOSE: To determine the natural history of the cardiac manifestations, determined by advanced transthoracic echocardiography (TTE), due to COVID-19 in multiethnic hospitalised patients. METHODS: A prospective observational study, in a London NHS Trust, of patients admitted with COVID-19 undergoing TTE. Baseline TTE was taken during acute admission with follow-up TTE at a median of 17.6 months to assess the same left ventricular (LV), right ventricular (RV) and pulmonary pressure parameters with additional 3D and strain measures. RESULTS: There were a total of 117 patients with admission and follow-up TTE. LV parameters were largely unchanged at follow-up except E/A ratio decreasing from 0.98 to 0.85. LV global longitudinal strain measures detected subclinical LV impairment in 36% of patients. RV dimensions improved (mean mid RV diameter, 3.1 cm to 2.7 cm (p < 0.001)) but with persistence of RV impairment at follow-up (28%). 3D RV ejection fraction and global strain measures determined impairment in around 40% of patients. All pulmonary haemodynamic measures showed improvement with resolution of effects of RV afterload (p = 0.016), decrease in pulmonary artery systolic pressure (36 mmHg to 28 mmHg p = 0.032) and improvements in mean pulmonary valve acceleration time (113 ms to 120 ms), p = 0.025, and pulmonary vascular resistance (2.2 to 1.7 WU), p = 0.01. CONCLUSION: Follow-up echocardiographic parameters compared to admission parameters of multiethnic hospitalised patients with COVID-19 demonstrate improved pulmonary haemodynamics but persistent LV and RV impairment which suggest possible myocarditic/microthrombotic lasting effects of COVID-19 infection.