Dynamics of global and segmental strain as a marker of right ventricular contractility recovery in patients after COVID-19 pneumonia

Aim. To study the changes of morphological and functional right ventricular (RV) parameters depending on the severity of coronavirus infection 2019 (COVID-19) pneumonia over long-term follow-up.

Material and methods. A total of 200 patients (men, 51,5%, mean age, 51,4±10,9 years) were examined at 2 control visits (3, 12 months after receiving two negative polymerase chain reaction tests). Patients were divided into following groups: group I (n=94) — lung tissue involvement ≥50% according to inhospital chest computed tomography (chest CT), group II (n=106) — lung tissue involvement˂50% according to chest CT.

Results. The groups were comparable in key clinical and functional parameters 3 months after COVID-19 pneumonia. Speckle tracking echocardiography (STE) revealed a significant increase in following global longitudinal strain (LS) parameters: RV free wall endocardial LS (-22,7±3,2% and -24,3±3,8% in group I, p<0,001; -23,2±3,5% and -24,5±3,4% in group II, p><0,001), and RV endocardial LS (-21,0±3,1% and -22,5±3,7% in group I, p><0,001, -21,5±3,2% and -22,6±3,3% in group II, p=0,001 ). Significant increase of segmental endocardial LS was revealed in group I in the basal segments of RV free wall (-26,2±5,1% and -28,1±5,1%, p=0,004) and interventricular septum (IVS) (-16,2 [13,9; 19,5]% and -17,5 [14,6; 21,4]%, p=0,024), IVS middle segment (-20,3±4,1% and -21,5±4,8%, p=0,030), as well as in group II in the apical segments of RV free wall (-21,9±6,7% and -24,4±5,2%, p=0,001) and IVS (-23,7±4,7% and -24,9±4,8%, p=0,014). Conclusion. Recovery of RV function during a 12-month follow-up period in patients with both severe and moderate/mild lung involvement in COVID-19 was detected using the STE method.>˂0,001; -23,2±3,5% and -24,5±3,4% in group II, p˂0,001), and RV endocardial LS (-21,0±3,1% and -22,5±3,7% in group I, p˂0,001, -21,5±3,2% and -22,6±3,3% in group II, p=0,001 ). Significant increase of segmental endocardial LS was revealed in group I in the basal segments of RV free wall (-26,2±5,1% and -28,1±5,1%, p=0,004) and interventricular septum (IVS) (-16,2 [13,9; 19,5]% and -17,5 [14,6; 21,4]%, p=0,024), IVS middle segment (-20,3±4,1% and -21,5±4,8%, p=0,030), as well as in group II in the apical segments of RV free wall (-21,9±6,7% and -24,4±5,2%, p=0,001) and IVS (-23,7±4,7% and -24,9±4,8%, p=0,014).

Conclusion. Recovery of RV function during a 12-month follow-up period in patients with both severe and moderate/mild lung involvement in COVID-19 was detected using the STE method.

1. Li Y, Li H, Zhu S, et al. Prognostic value of right ventricular longitudinal strain in pa - tients with COVID-19. Cardiovascular Imaging. 13(11),2020,2287-99. doi:10.1016/j.jcmg.2020.04.014.

2. Bleakley C, Singh S, Garfield B, et al. Right ventricular dysfunction in critically ill COVID-19 ARDS. International Journal of Cardiology. 2021,327:251-8. doi:10.1016/j.ijcard.2020.11.043.

3. Голухова Е.З., Сливнева И.В., Рыбка М.М. и др. Систолическая дисфункция правого желудочка как предиктор неблагоприятного исхода у пациентов с COVID-19. Кардиология. 2020;60(11):16-29. doi:10.18087/cardio.2020.11.n1303.

4. Akkaya F, Yenerçağ FNT, Kaya A, et al. Long term effects of mild severity COVID-19 on right ventricular functions. The International Journal of Cardiovascular Imaging. 2021;37(12):3451-7. doi:10.1007/s10554-021-02340-x.

5. Günay N, Demiröz Ö, Kahyaoğlu M, et al. The effect of moderate and severe COVID19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis. The International Journal of Cardiovascular Imaging. 2021;37(6):1883-90. doi:10.1007/s10554-021-02171-w.

6. Ozer PK, Govdeli EA, Baykiz D, et al. Impairment of right ventricular longitudinal strain associated with severity of pneumonia in patients recovered from COVID-19 The International Journal of Cardiovascular Imaging, 2021;37(8):2387-97. doi:10.1007/s10554-021-02214-2.

7. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal — Cardiovascular Imaging. 2015;16(3):233-71. doi:10.1093/ehjci/jev014.

8. Otto K.M. The Practice of Clinical Echocardiography. 6th Edition — May 22, 2021. 1024 p. Hardcover ISBN: 9780323697286; eBook ISBN: 9780323697293.

9. Abbas AE, Fortuin FD, Schiller NB, et al. A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol. 2003;41(6):1021-7. doi:10.1016/ s0735-1097(02)02973-x.

10. Medvedofsky D, Koifman E, Jarrett H, et al. Association of right ventricular longitudinal strain with mortality in patients undergoing transcatheter aortic valve replacement. Journal of the American Society of Echocardiography. 2020;33(4),452-60. doi:10.1016/j.echo.2019.11.014.

11. Bieber S, Kraechan A, Hellmuth JC, et al. Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury. Infection. 2021;49(3):491-500. doi:10.1007/s15010-020-01572-8.

12. Young KA, Krishna H, Jain V, et al. Serial Left and Right Ventricular Strain Analysis in Patients Recovered from COVID-19. Journal of the American Society of Echocardiography. 2022;S0894-7317(22)00310-8. doi:10.1016/j.echo.2022.06.007.

13. Широков Н.Е., Ярославская Е.И., Криночкин Д.В., Осокина Н.А. Скрытая систолическая дисфункция правого желудочка у пациентов с повышением легочного сосудистого сопротивления через 3 мес после COVID-19-пневмонии. Кардиология. 2022;62(3):16-20. doi:10.18087//cardio.2022.3.n1743.

14. Li AL, Zhai ZG, Zhai YN, et al. The value of speckle-tracking echocardiography in identifying right heart dysfunction in patients with chronic thromboembolic pulmonary hypertension. Int J Cardiovasc Imaging. 2018;34(12):1895-904. doi:10.1007/s10554- 018-1423-0.

15. Sunbul M, Kepez A, Kivrak T, et al. Right ventricular longitudinal deformation parameters and exercise capacity: prognosis of patients with chronic thromboembolic pulmonary hypertension. Herz. 2014;39(4):470-5. doi:10.1007/s00059-013-3842-y.

16. McGonagle D, O’Donnell JS, Sharif K, et al. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol. 2020;2(7):e437-e445. doi:10.1016/S2665-9913(20)30121-1.