斑点追踪超声心动图在识别轻症 COVID-19 后年轻成年人亚临床心肌功能障碍中的作用。
The usefulness of speckle tracking echocardiography in identifying subclinical myocardial dysfunction in young adults recovered from mild COVID-19.
机构信息
Unit of Cardiology, Luigi Sacco University Hospital, Milan, Italy.
Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Italy.
出版信息
Echocardiography. 2022 Sep;39(9):1190-1197. doi: 10.1111/echo.15431. Epub 2022 Jul 29.
BACKGROUND
Myocardial strain assessed with speckle tracking echocardiography is a sensitive marker of cardiac dysfunction. Both left-ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were affected by severe SARS-CoV-2 infection. However, data about cardiac involvement in patients with asymptomatic/mild Coronavirus disease-19 (COVID-19) is still lacking.
AIM
To evaluate myocardial function using LV-GLS and RV-LS in patients with previous asymptomatic/mild COVID-19.
METHODS
Forty young adults without previously known comorbidities/cardiovascular risk factors and with a confirmed diagnosis of asymptomatic or paucisymptomatic SARS-CoV-2 infection were retrospectively included. A 2D-transthoracic echocardiogram with speckle tracking analysis was performed at least 3 months after the diagnosis. Forty healthy subjects, matched for age, sex, and body surface area in a 1:1 ratio were used as the control group.
RESULTS
Left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and RV-LS were comparable between the two groups. LV-GLS was significantly lower in the cases compared to the control group (-22.7 ± 1.6% vs. -25.7 ± 2.3%; p < .001). Moreover, the prevalence of regional peak systolic strain below -16% in at least two segments was three times higher in patients with previous COVID-19 compared to controls (30% vs. 10%, p = .02). In multivariable logistic regression, previous COVID-19 infection was independently associated with reduced LV-GLS values (p < .001).
CONCLUSION
SARS-CoV-2 infection may affect left ventricular deformation in 30% of young adult patients despite an asymptomatic or only mildly symptomatic acute illness. Speckle-tracking echocardiography could help early identification of patients with subclinical cardiac involvement, with potential repercussions on risk stratification and management.
背景
斑点追踪超声心动图评估的心肌应变是心脏功能障碍的敏感标志物。左心室整体纵向应变（LV-GLS）和右心室纵向应变（RV-LS）均受严重 SARS-CoV-2 感染的影响。然而，关于无症状/轻度冠状病毒病 19 （COVID-19）患者心脏受累的数据仍然缺乏。
目的
使用 LV-GLS 和 RV-LS 评估先前无症状/轻度 COVID-19 患者的心肌功能。
方法
回顾性纳入 40 名无先前已知合并症/心血管危险因素且确诊无症状或轻症 SARS-CoV-2 感染的年轻成年人。在诊断后至少 3 个月进行二维经胸超声心动图斑点追踪分析。以 1:1 的比例按年龄、性别和体表面积匹配 40 名健康对照者。
结果
两组左心室射血分数（LVEF）、三尖瓣环平面收缩期位移（TAPSE）和 RV-LS 无差异。与对照组相比，病例组的 LV-GLS 明显降低（-22.7 ± 1.6%比-25.7 ± 2.3%；p <.001）。此外，与对照组相比（30%比 10%，p =.02），以前患有 COVID-19 的患者至少两个节段的局部峰值收缩应变低于-16%的患病率高 3 倍。在多变量逻辑回归中，以前的 COVID-19 感染与 LV-GLS 值降低独立相关（p <.001）。
结论
尽管急性疾病为无症状或仅有轻度症状，SARS-CoV-2 感染仍可能影响 30%的年轻成年患者的左心室变形。斑点追踪超声心动图可帮助早期识别无症状心脏受累患者，对危险分层和管理具有潜在影响。
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