Zhang Mengjiao, Chen Jianxiong, Wu Lingheng, Xi Guiyang, Li Xinyi, Jin Lin, Li Zhaojun
Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201803, China.
School of Medical Imaging, Shandong Second Medical University, Weifang, 261053, China.
BMC Cardiovasc Disord. 2025 Aug 13;25(1):602. doi: 10.1186/s12872-025-04971-7.
Cardiac dysfunction is commonly observed in COVID-19 patients, but its impact on different myocardial layers-endocardial, mid-myocardial, and epicardial remains insufficiently understood. This study aims to evaluate myocardial dysfunction in COVID-19 patients by assessing both the long-axis and short-axis function of the left ventricle (LV) using two-dimensional myocardial layer-specific strain imaging.
A total of 197 COVID-19 patients were enrolled and categorized into three subgroups: mild, moderate, and severe. Cardiac structural and functional indices, along with biomarker levels, were collected to analyze their correlation with global longitudinal strain (GLS) and global circumferential strain (GCS).
GLS and GCS were reduced in moderate and severe COVID-19 patients, including layer-specific GLS and GCS (both p < 0.05). E/A ratio, left ventricular ejection fraction (LVEF), and myoglobin were identified as independent factors influencing GLS (all p < 0.05). Age, LVEF, cardiac troponin I (cTnI), and myoglobin were independent factors influencing GCS (p < 0.05). Furthermore, B-type Natriuretic Peptide (BNP) and myoglobin were identified as independent predictors of both GLS in the whole wall (GLSww) and endocardial (GLSendo), with β values of -0.22, -0.21 and -0.39, -3.70, respectively (all p < 0.05). GLS, including endocardial, mid-myocardial, and epicardial myocardial layers, demonstrated superior diagnostic performance compared to GCS, with AUC values of 0.81, 0.83, and 0.84 vs. 0.61, 0.57, and 0.55, respectively (all p < 0.001).
There are differences in myocardial injury caused by COVID-19 across different layers of the myocardium, both in the longitudinal and circumferential directions, with more pronounced damage observed in the inner myocardium. GLS demonstrated superior diagnostic performance compared to GCS in identifying myocardial dysfunction. Furthermore, myocardial dysfunction was correlated with blood pressure, myocardial structure, and biochemical markers.
新冠病毒病（COVID-19）患者中常观察到心脏功能障碍，但其对不同心肌层（心内膜、心肌中层和心外膜）的影响仍未得到充分了解。本研究旨在通过使用二维心肌层特异性应变成像评估左心室（LV）的长轴和短轴功能，来评估COVID-19患者的心肌功能障碍。
共纳入197例COVID-19患者，并分为三个亚组：轻度、中度和重度。收集心脏结构和功能指标以及生物标志物水平，以分析它们与整体纵向应变（GLS）和整体圆周应变（GCS）的相关性。
中度和重度COVID-19患者的GLS和GCS降低，包括各层特异性GLS和GCS（均p<0.05）。E/A比值、左心室射血分数（LVEF）和肌红蛋白被确定为影响GLS的独立因素（均p<0.05）。年龄、LVEF、心肌肌钙蛋白I（cTnI）和肌红蛋白是影响GCS的独立因素（p<0.05）。此外，B型利钠肽（BNP）和肌红蛋白被确定为全层（GLSww）和心内膜（GLSendo）GLS的独立预测因子，β值分别为-0.22、-0.21和-0.39、-3.70（均p<0.05）。包括心内膜、心肌中层和心外膜心肌层的GLS与GCS相比，显示出更好的诊断性能，AUC值分别为0.81、0.83和0.84，而GCS的AUC值分别为0.61、0.57和0.55（均p<0.001）。
COVID-19所致心肌损伤在心肌不同层的纵向和圆周方向均存在差异，心内膜下损伤更为明显。在识别心肌功能障碍方面，GLS与GCS相比显示出更好的诊断性能。此外，心肌功能障碍与血压、心肌结构和生化标志物相关。
