Schellenberg J, Matits L, Bizjak D A, Kersten J, Kirsten J, Vollrath S, Steinacker J M
Division of Sports and Rehabilitation Medicine, University Ulm Hospital, Ulm, Germany.
Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.
Front Cardiovasc Med. 2023 Oct 9;10:1240278. doi: 10.3389/fcvm.2023.1240278. eCollection 2023.
It has not yet been conclusively determined whether reduced left ventricular global longitudinal strain (LV GLS) after COVID-19 contributes to a reduction in exercise capacity. Our own studies showed a possible mild myocardial involvement in the form of reduced LV GLS in athletes after COVID-19 compared with healthy athletes. The aims of this prospective follow-up study were to investigate the development of LV GLS over a 3-month period in athletes after COVID-19 and the possible relationship between LV GLS and physical performance.
LV GLS was determined in four-, two-, and three-chamber views and assessed offline by a blinded investigator in 96 recreational athletes (mean age 33.15 ± 12.40 years, 53 male, peak VO 38.82 ± 11.14 ml/min/kg) at a median of two () and five months () after COVID-19. Cardiopulmonary exercise testing (CPET) was performed on a bicycle ergometer on both examination dates.
LV GLS improved significantly between and ( -18.82 ± 2.02 vs. -19.46 ± 2.05, < 0.001). Echocardiographic and spiroergometric parameters were within the normal clinical reference range. Maximum power increased significantly from to ( 283.17 ± 83.20 vs. 286.24 ± 85.22 Watt, = 0.009) and there was a trend toward increased peak oxygen uptake ( 36.82 ± 11.14 vs. 38.68 ± 10.26 ml/min/kg, = 0.069). We found no correlation between LV GLS and performance parameters, except for the respiratory exchange ratio (RER) [ -0.316, (-0.501; -0.102), < 0.050].
Significant improvement in LV GLS approximately five months after COVID-19 may be due to mild myocardial involvement during or shortly after COVID-19, which seems to recover. There was no correlation between LV GLS and performance parameters, except for an inverse correlation of LV GLS and RER, suggesting insufficient exercise intolerance at lower GLS values. Further studies on the development of GLS in athletes or in the general population with moderate and severe disease courses would be informative as well as the comparison of pre-COVID-19 with post-COVID-19 echocardiography to evaluate the effects of COVID-19 on cardiac function.
新冠病毒病（COVID-19）后左心室整体纵向应变（LV GLS）降低是否会导致运动能力下降尚未有定论。我们自己的研究表明，与健康运动员相比，COVID-19后的运动员可能存在以LV GLS降低形式出现的轻度心肌受累。这项前瞻性随访研究的目的是调查COVID-19后运动员在3个月内LV GLS的变化情况以及LV GLS与身体表现之间的可能关系。
对96名休闲运动员（平均年龄33.15±12.40岁，53名男性，峰值摄氧量38.82±11.14 ml/min/kg）在COVID-19后的中位数2个月（）和5个月（）时，通过四腔、两腔和三腔视图测定LV GLS，并由一名盲法研究者进行离线评估。在两次检查日期均在自行车测力计上进行心肺运动测试（CPET）。
与之间LV GLS有显著改善（-18.82±2.02 vs. -19.46±2.05，<0.001）。超声心动图和运动气体代谢参数在正常临床参考范围内。最大功率从显著增加到（283.17±83.20 vs. 286.24±85.22瓦，=0.009），并且峰值摄氧量有增加趋势（36.82±11.14 vs. 38.68±10.26 ml/min/kg，=0.069）。我们发现LV GLS与表现参数之间无相关性，除了呼吸交换率（RER）[-0.316，（-0.501；-0.102），<0.050]。
COVID-19后约五个月LV GLS的显著改善可能是由于COVID-19期间或之后不久的轻度心肌受累，而这种受累似乎有所恢复。LV GLS与表现参数之间无相关性，除了LV GLS与RER呈负相关，提示较低GLS值时运动不耐受不足。对运动员或患有中度和重度病程的普通人群中GLS变化的进一步研究以及COVID-19前与COVID-19后超声心动图的比较以评估COVID-19对心脏功能的影响将很有意义。
