Cardiac Function and Functional Capacity in Patients With Long COVID: A Comparison to Propensity-Matched Community Controls - 02/01/25
, Noah Wexler, MBBS a, c, Joel Smith, MSc a, Leah Wright, PhD a, c, Felicia Ho, MBBS a, c, Marc Oreto, BSc a, c, Ashleigh-Georgia Sherriff, BSc a, c, Richard Allwood, BSc a, Yusuke Sata, MD, PhD a, Stefano Manca, PhD a, Erin Howden, PhD a, b, Quan Huynh, PhD a, b
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Abstract |
Background |
Cardiac impairment has been associated with acute COVID-19 since the earliest reports of the pandemic. However, its role in postacute sequelae of COVID-19 (“long COVID”) is undefined, and many existing observations about cardiovascular involvement in postacute sequelae of COVID-19 are uncontrolled.
Objective |
To compare the prevalence of cardiac dysfunction in patients with long COVID and noninfected controls from the same community and explore their association with functional capacity.
Methods |
Echocardiography was used to assess cardiac structure and function, including the measurement of global longitudinal strain (GLS), in 190 participants with long COVID. All underwent assessment of functional impairment by subjective (Duke Activity Status Index) and objective tests (6-minute walk test). The 190 participants from the long COVID group were matched with those from 979 patients who underwent the same tests in the pre-COVID-19 era, using a propensity score.
Results |
The 190 patients with long COVID had similar age and risk factor profiles to those of their matched controls. Left ventricular dimensions and geometry, but not diastolic parameters, were significantly altered in the long COVID group. The long COVID group had subclinical systolic dysfunction (GLS 18.5% ± 2.6% vs 19.3% ± 2.7%, P = .005), and more long COVID patients had abnormal (<16%) GLS (13% vs 8%, P = .035). The association of long COVID with abnormal GLS (odds ratio, 1.49 [1.04, 2.45]) was independent of—and had a similar or greater effect size than—age and risk factors. There was no interaction of long COVID with the association of risk factors with GLS. As expected, the long COVID group had significant subjective (<85% predicted METS; 72% vs 5%, P < .001) and objective functional impairment (29% vs 24%, P = .026), but GLS was only weakly associated with both subjective (r = 0.30, P = .005) and objective (r = 0.21, P = .05) functional impairment. The presence of long COVID was independently associated with subjective (odds ratio = 159.7 [95% CI, 61.6-414.2]) and objective functional impairment (odds ratio = 2.8 [95% CI, 1.5-5.2]).
Conclusions |
Impaired GLS and left ventricular dimensions are the echocardiographic features that are overrepresented in long COVID, and this association is similar to and independent of other risk factors. Impaired GLS is weakly associated with functional impairment.
Le texte complet de cet article est disponible en PDF.Central Illustration |
This comparison in cardiac function and functional capacity in patients with long COVID to propensity-matched community controls shows that although diastolic markers were not different, LV strain (although many values were still within the normal range) was significantly worse than in control subjects. However, there was only a weak association of cardiac function with functional capacity.
This comparison in cardiac function and functional capacity in patients with long COVID to propensity-matched community controls shows that although diastolic markers were not different, LV strain (although many values were still within the normal range) was significantly worse than in control subjects. However, there was only a weak association of cardiac function with functional capacity.
Central IllustrationThis comparison in cardiac function and functional capacity in patients with long COVID to propensity-matched community controls shows that although diastolic markers were not different, LV strain (although many values were still within the normal range) was significantly worse than in control subjects. However, there was only a weak association of cardiac function with functional capacity.Le texte complet de cet article est disponible en PDF.
Highlights |
• | A study of echo and functional assessment of 212 people post-COVID was performed. |
• | The patients were matched to 979 patients tested in the pre-COVID era. |
• | More post-COVID patients had subclinical LV dysfunction (12% vs 7%, P = .04). |
• | Association of COVID with abnormal GLS was independent of age, sex, and risk factors. |
• | GLS was weakly associated with both subjective and objective functional impairment. |
Keywords : COVID-19, Post-acute sequelae of COVID-19, Long COVID, Myocardial dysfunction, Echocardiography and global longitudinal strain
Abbreviations : 2D, 6MWD, BMI, CMR, DASI, GLS, LV, METS, RV
Plan
| This study was supported in part by the National Heart Foundation, Canberra (105282) and the National Health and Medical Research Council, Canberra (2005874), Australia. |
Vol 38 - N° 1
P. 16 - janvier 2025 Retour au numéro
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