Matejova Gabriela, Radvan Martin, Bartecku Elis, Kamenik Martin, Koc Lumir, Horinkova Jana, Sykorova Lubica, Stepanova Radka, Kala Petr
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czechia.
Faculty of Medicine, Masaryk University, Brno, Czechia.
Front Cardiovasc Med. 2022 Dec 21;9:1067943. doi: 10.3389/fcvm.2022.1067943. eCollection 2022.
To evaluate the need for cardiac monitoring in unselected patients recovered from COVID-19 and to estimate the risk of heart complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
During March 2020 and January 2021, 106 patients who had recovered from SARS-CoV-2 (alpha and beta variants) were enrolled in prospective observational cohort study CoSuBr (Covid Survivals in Brno). The diagnosis was based on a reverse transcription-polymerase chain reaction swab test of the upper respiratory tract. Demographic parameters, patient history, clinical evaluation, cardiac biomarkers, ECG and echocardiography were recorded during three visits (Visit 1 at least 6 weeks after infection, Visit 2 three months later, and Visit 3 one year after Visit 1).
58.5% of the study group ( = 106) were female, while the mean age was 46 years (range 18-77 years). The mean time interval between the onset of infection and the follow-up visit was 107 days. One quarter (24.5%) of the patients required hospitalization during the acute phase of the disease; the rest recovered at home. 74% suffered a mild form of the disease, with 4.8, 18.1, and 2.9% suffering moderate, severe, and critical forms, respectively. At the time of enrolment, 64.2% of the patients reported persistent symptoms, while more than half of the whole group (50.9%) mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue). In the 1-year follow-up after COVID-19 infection, left ventricle ejection fraction showed no significant decrease [median (IQR) change was -1.0 (-6.0; 4.0)%, = 0.150], and there were no changes of troponin (mean change -0.1 ± 1.72 ng/L; = 0.380) or NT-proBNP [median (IQR) change 2.0 (-20.0; 29.0) pg/mL; = 0.315]. There was a mild decrease in right ventricle end diastolic diameter (-mean change 2.3 ± 5.61 mm, < 0.001), while no right ventricle dysfunction was detected. There was very mild progress in left ventricle diastolic diameter [median (IQR) change 1.0 (-1.0; 4.0) mm; = 0.001] between V1 and V3, mild enlargement of the left atrium (mean change 1.2 ± 4.17 mm; = 0.021) and a non-significant trend to impairment of left ventricle diastolic dysfunction. There was a mild change in pulmonary artery systolic pressure [median (IQR) change 3.0 (-2.0; 8.0) mmHg; = 0.038].
Despite a lot of information regarding cardiac impairment due to SARS-CoV2, our study does not suggest an increased risk for developing clinically significant heart changes during the 1-year follow-up. Based on our results, routine echocardiography and biomarkers collection is currently not recommended after COVID-19 recovery.
评估未经过挑选的新冠病毒病康复患者进行心脏监测的必要性，并估计严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染后心脏并发症的风险。
在2020年3月至2021年1月期间，106例从SARS-CoV-2（α和β变异株）感染中康复的患者被纳入前瞻性观察队列研究CoSuBr（布尔诺新冠康复者研究）。诊断基于上呼吸道的逆转录-聚合酶链反应拭子检测。在三次就诊时（感染后至少6周的第1次就诊、3个月后的第2次就诊以及第1次就诊后1年的第3次就诊）记录人口统计学参数、患者病史、临床评估、心脏生物标志物、心电图和超声心动图。
研究组中58.5%（n = 106）为女性，平均年龄为46岁（范围18 - 77岁）。感染 onset与随访就诊之间的平均时间间隔为107天。四分之一（24.5%）的患者在疾病急性期需要住院治疗；其余患者在家中康复。74%的患者为轻症，中度、重度和危重症患者分别占4.8%、18.1%和2.9%。在入组时，64.2%的患者报告有持续症状，而超过半数（50.9%）的患者提到至少一种可能源于心脏的症状（呼吸问题、心悸、运动不耐受、疲劳）。在新冠病毒感染后的1年随访中，左心室射血分数无显著下降[中位数（四分位间距）变化为 -1.0（-6.0；4.0）%，P = 0.150]，肌钙蛋白无变化（平均变化 -0.1 ± 1.72 ng/L；P = 0.380）或N末端脑钠肽前体[中位数（四分位间距）变化2.0（-20.0；29.0）pg/mL；P = 0.315]。右心室舒张末期内径有轻度减小（平均变化 -2.3 ± 5.61 mm，P < 0.001），但未检测到右心室功能障碍。在V1和V3之间，左心室舒张末期内径有非常轻微的进展[中位数（四分位间距）变化1.0（-1.0；4.0）mm；P = 0.001]，左心房轻度增大（平均变化1.2 ± 4.17 mm；P = 0.021），并且左心室舒张功能障碍有不显著的恶化趋势。肺动脉收缩压有轻度变化[中位数（四分位间距）变化3.0（-2.0；8.0）mmHg；P = 0.038]。
尽管有许多关于SARS-CoV2所致心脏损害的信息，但我们的研究并不表明在1年随访期间发生具有临床意义的心脏变化的风险增加。基于我们的结果，目前不建议在新冠康复后常规进行超声心动图检查和收集生物标志物。
