Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
Department of Cardiology, Faculty of Medicine (for Boys), Al-Azhar University, Cairo, Egypt.
BMC Cardiovasc Disord. 2024 Aug 16;24(1):429. doi: 10.1186/s12872-024-03982-0.
A relatively common complication of COVID -19 infection is arrhythmia. There is limited information about myocardial deformation and heart rate variability (HRV) in symptomatic post COVID patients presented by ventricular arrhythmia.
Our goal was to assess 2D-ventricular strain and heart rate variability indices (evaluated by ambulatory ECG monitoring) in post-COVID-19 patients suffering from ventricular arrhythmia.
The current observational case-control study performed on 60 patients one month after they had recovered from the COVID-19 infection. Thirty healthy volunteers served as the control group. Each participant had a full medical history review, blood tests, a 12-lead surface electrocardiogram (ECG), 24-h ambulatory ECG monitoring, and an echo-Doppler examination to evaluate the left ventricular (LV) dimensions, tissue Doppler velocities, and 2D-speckle tracking echocardiography (2D-STE) for both the LV and right ventricular (RV) strain.
Symptomatic post-COVID patients with monomorphic premature ventricular contractions (PVCs) showed a substantial impairment of LV/RV systolic and diastolic functions, LV/RV myocardial performance (MPI) with reduced indices of HRV. Patients with higher versus lower ventricular burden had poorer functional status, higher levels of inflammatory biomarkers and reduced parameters of HRV (New York Heart Association (NYHA) class: 2.1 ± 0.9 vs. 1.5 ± 0.6, p < 0.001, C-reactive protein (CRP): 13.3 ± 4.1 vs. 8.3 ± 5.9 mg/L, p < 0.0001, low frequency/high frequency (LF/HF): 3.6 ± 2.4 vs. 2.2 ± 1.2, p < 0.002, the root mean square of the difference between successive normal intervals (rMSSD): 21.8 ± 4.7 vs. 29.3 ± 14.9 ms, p < 0.039 and the standard deviation of the RR interval (SDNN): 69.8 ± 19.1 vs.108.8 ± 37.4 ms, p < 0.0001). The ventricular burden positively correlated with neutrophil/lymphocyte ratio (NLR) (r = 0.33, p < 0.001), CRP (r = 0.60, p < 0.0001), while it negatively correlated with LV-global longitudinal strain (GLS) (r = -0.38, p < 0.0001), and RV-GLS (r = -0.37, p < 0.0001).
Patients with post-COVID symptoms presented by ventricular arrhythmia had poor functional status. Patients with post-COVID symptoms and ventricular arrhythmia had subclinical myocardial damage, evidenced by speckle tracking echocardiography while having apparently preserved LV systolic function. The burden of ventricular arrhythmia in post-COVID patients significantly correlated with increased inflammatory biomarkers and reduced biventricular strain.
COVID-19 感染的一个相对常见的并发症是心律失常。在有症状的 COVID 后患者中，心室性心律失常患者的心肌变形和心率变异性（HRV）的信息有限。
我们的目标是评估 COVID-19 后出现心室性心律失常的患者的 2D 心室应变和心率变异性指数（通过动态心电图监测评估）。
本研究为回顾性病例对照研究，纳入了 COVID-19 感染后一个月恢复的 60 例患者。30 名健康志愿者作为对照组。每位患者均进行了全面的病史回顾、血液检查、12 导联体表心电图（ECG）、24 小时动态心电图监测以及超声心动图检查，以评估左心室（LV）的尺寸、组织多普勒速度以及左心室（LV）和右心室（RV）的二维斑点追踪超声心动图（2D-STE）应变。
有单形性室性早搏（PVC）症状的 COVID 后患者，LV/RV 收缩和舒张功能明显受损，LV/RV 心肌收缩性能（MPI）降低，HRV 指数降低。与心室负荷较低的患者相比，心室负荷较高的患者功能状态较差，炎症生物标志物水平较高，HRV 参数降低（纽约心脏协会（NYHA）分级：2.1±0.9 与 1.5±0.6，p<0.001，C 反应蛋白（CRP）：13.3±4.1 与 8.3±5.9 mg/L，p<0.0001，低频/高频（LF/HF）：3.6±2.4 与 2.2±1.2，p<0.002，连续正常间期的均方根差（rMSSD）：21.8±4.7 与 29.3±14.9 ms，p<0.039，RR 间期标准差（SDNN）：69.8±19.1 与 108.8±37.4 ms，p<0.0001）。心室负荷与中性粒细胞/淋巴细胞比值（NLR）呈正相关（r=0.33，p<0.001），与 CRP 呈正相关（r=0.60，p<0.0001），与 LV 整体纵向应变（GLS）呈负相关（r=-0.38，p<0.0001），与 RV-GLS 呈负相关（r=-0.37，p<0.0001）。
有症状的 COVID 后出现心室性心律失常的患者功能状态较差。有症状的 COVID 后合并心室性心律失常的患者存在亚临床心肌损伤，斑点追踪超声心动图可证实，而左心室收缩功能似乎正常。COVID 后患者的心室性心律失常负担与炎症生物标志物的增加和双心室应变的降低显著相关。
