AUTHOR=Olszanecka Agnieszka , Wojciechowska Wiktoria , Bednarek Agnieszka , Kusak Piotr , Wizner Barbara , Terlecki Michał , Stolarz-Skrzypek Katarzyna , Klocek Marek , Drożdż Tomasz , Sładek Krzysztof , Bociąga-Jasik Monika , Garlicki Aleksander , Rewiuk Krzysztof , Matyja Andrzej , Małecki Maciej , Sydor Wojciech , Krzanowski Marcin , Grodzicki Tomasz , Rajzer Marek 

TITLE=Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1230669

DOI=10.3389/fcvm.2023.1230669

ISSN=2297-055X

ABSTRACT=It is well known that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions.  The insight into the cardiovascular involvement and sequelae in those with no preexisting conditions is poor.
The aim of the study was to analyze the influence of COVID-19 on cardiac performance in subjects  with no prior history of structural heart disease. The study is part of the CRACoV project, with a prospective design and a 12-month follow-up. 
Material and methods.  The study included 229 patients hospitalized with diagnosed COVID-19 (median age of 59 years, 81 women). In all participants standard clinical assessment and laboratory tests were performed.  An extended echocardiographic image acquisition was performed at baseline and at a 3, 6 and 12 month follow-up. All analyses were performed off-line. Series of echocardiographic parameters were compared with repeated measures or Friedman analysis of variance.
Results.  In all subjects, the baseline left ventricular ejection fraction  (LVEF) was preserved (63.0%; Q1:Q3 [60.0-66.0]). In 21.3 % of patients elevated levels of  high-sensitivity cardiac troponin T  and in 55.8% elevated NT-pro-BNP were detected. At one year follow-up , LV diameter and volume did not change significantly (LV 48.0 ±5.2 vs 47.8±4.8 mm, p=0.08), while a significant improvement of parameters of  biventricular strain were observed (LV -19.1±3.3 vs -19.7 ±2.5%, p=0.01 and RV -19.9±4.5 vs -23.2±4.9%, p=0.002). Additionally, decrease in LV wall thickness was observed  (interventricular septum  10.4±1.6 vs 9.7±2.0 mm, p<0.001; LV posterior wall  9.8 ±1.4 vs 9.1± 1.5 mm, p<0.001).). 
Conclusions: In acute phase of COVID-19 the elevation of  cardiac biomarkers in subjects with normal left ventricular ejection fraction is a frequent occurrence, however does not translate into clinically significant cardiac dysfunction after one year. Serial echocardiograms conducted in patients without preexisting structural heart disease demonstrate an overall trend towards improved cardiac  function during one-year follow-up and reduced myocardial thickening. This suggests that in patients without preexisting conditions, the acute cardiac consequences of COVID-19 are associated with systemic inflammation and hemodynamic stress.