Varshney Amit, Rawat Ramakant
Department of Emergency Medicine, Kanti Devi Medical College Hospital and Research Center, Mathura, Uttar Pradesh, India.
Department of Medicine, U.P. University of Medical Sciences, Safai, Etawah, Uttar Pradesh, India.
Glob Cardiol Sci Pract. 2023 Aug 1;2023(3):e202319. doi: 10.21542/gcsp.2023.19.
The delta variant of SARS-CoV-2 has been associated with increased mortality and multi-organ failure, affecting various systems in the body. Cardiovascular manifestations including arrhythmias, heart failure, myocarditis, myocardial damage, and thromboembolism are commonly observed in patients infected with the delta variant.
This study enrolled 106 individuals who tested positive for the delta strain of SARS-CoV-2 using real-time RT-PCR between May 25, 2020, and October 15, 2021. All patients underwent 2-D echocardiography, and based on the severity of their infection, were divided into two groups: serious and non-serious.
Univariate correlation analysis showed significant positive correlations between right ventricular (RV) diameter and hs-TnI and D-dimer levels. Conversely, left ventricular ejection fraction (LVEF) was negatively correlated with hs-TnI, C-reactive protein (CRP), and D-dimer levels. Additionally, RV fractional area change (RV-FAC) showed a negative correlation with D-dimer and hs-TnI levels but not with CRP levels.
RV dysfunction has been identified as an important predictor of mortality in various patient populations, including those infected with the delta variant of SARS-CoV-2. A significant proportion of severe delta variant cases require mechanical ventilation, which can have hemodynamic effects on the ventricular performance. Mechanical ventilation can increase pulmonary arterial pressure and worsen right heart dysfunction, especially when lung-protective ventilation strategies are not optimized.
Our study highlights that patients with severe delta variants, particularly those with cardiac injury, may exhibit biventricular systolic dysfunction. Echocardiographic parameters such as LVEF, RV diameter, and RV-FAC were found to be associated with laboratory markers of poor prognosis, including elevated hs-TnI, CRP, and D-dimer levels. 2-D echocardiography can be a valuable tool in identifying early signs of ventricular dysfunction, aiding in the management of this patient population.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的德尔塔变异株与死亡率增加和多器官衰竭相关，会影响身体的各个系统。感染德尔塔变异株的患者中常见心血管表现，包括心律失常、心力衰竭、心肌炎、心肌损伤和血栓栓塞。
本研究纳入了2020年5月25日至2021年10月15日期间使用实时逆转录聚合酶链反应（RT-PCR）检测出SARS-CoV-2德尔塔毒株呈阳性的106名个体。所有患者均接受了二维超声心动图检查，并根据感染的严重程度分为两组：重症组和非重症组。
单因素相关性分析显示，右心室（RV）直径与高敏肌钙蛋白I（hs-TnI）和D-二聚体水平呈显著正相关。相反，左心室射血分数（LVEF）与hs-TnI、C反应蛋白（CRP）和D-二聚体水平呈负相关。此外，右心室面积变化分数（RV-FAC）与D-二聚体和hs-TnI水平呈负相关，但与CRP水平无关。
右心室功能障碍已被确定为包括感染SARS-CoV-2德尔塔变异株患者在内的各种患者群体死亡率的重要预测指标。相当一部分重症德尔塔变异株病例需要机械通气，这可能会对心室功能产生血流动力学影响。机械通气可增加肺动脉压并加重右心功能障碍，尤其是在肺保护性通气策略未优化的情况下。
我们的研究强调，重症德尔塔变异株患者，尤其是那些有心脏损伤的患者，可能会出现双心室收缩功能障碍。发现超声心动图参数如LVEF、RV直径和RV-FAC与预后不良的实验室指标相关，包括hs-TnI、CRP和D-二聚体水平升高。二维超声心动图可成为识别心室功能障碍早期迹象的有价值工具，有助于对该患者群体的管理。
