Role of Speckle Tracking Echocardiography in the Assessment of Subclinical Left Ventricular Dysfunction in Post COVID-19 Patients

Abstract

Background: The utilization of two-dimensional speckle-tracking echocardiography (2-D STE) serves as a precise measurable technique for conducting an assessment of both global and localized cardiac performance, exhibiting remarkable sensitivity. Its utility is particularly noteworthy in the early identification of cardiac impairments that are not clinically evident. This study’s objective was to investigate the effectiveness of STE in identifying latent left ventricular dysfunction among individuals who have recuperated from COVID-19. Methods: This study was conducted at a single center; this analytical cross-sectional analysis involved 100 individuals over the age of 18. The study comprised two cohorts: one with 50 post COVID-19 patients, confirmed through a positive PCR test within a month of diagnosis, and a control group of 50 healthy subjects be compatible for age, sex, and risk factors. Subsequently, the post COVID-19 patients were stratified based on high-sensitivity troponin levels into two subgroups: Group I included those exhibiting signs of myocardial damage, while Group II consisted of patients showing no evidence of myocardial injury. Results: Elderly individuals, a greater prevalence of hypertension (HTN), raised levels of D-dimer and, serum C-reactive protein (CRP) along with increased Left ventricular end-diastolic volume (LVEDV) and diminished Left ventricular global longitudinal strain (LVGLS) over a one-month observation period, were all significantly linked to myocardial injury, as indicated by a p-value < 0.05. The LVGLS was a reliable indicator of cardiac injuries in COVID-19 survivors, with an AUC of 0.947 and a CI ranging from 0.886 to 1.00 (P < 0.001), particularly at a threshold of ≤ -20%, where it achieved 87.2% sensitivity and 100% specificity. Approximately 35 patients exhibited an LVGLS below this threshold. Furthermore, D-dimer and CRP levels post COVID-19 were notably elevated in those with cardiac injuries in comparison with those not, a difference that was statistically significant (P < 0.05). Furthermore, during the follow-up after one month period, post COVID-19 CRP levels, LVEDV, and LVGLS remained significantly higher in patients with myocardial injury in comparison with those didn’t have myocardial injury (p < 0.05). Conclusions: LV GLS is acknowledged as a noteworthy, autonomous predictor of outcome for myocardial injury in individuals diagnosed with COVID-19. This metric offers preliminary insights into the infection’s severity, potentially aiding in the early intervention and management strategies for affected patients.