Xujuan Pu1, #, Jingjing Huang1, #, Jianjian Liu1, Dou Wu1, Xia Shi1, Xin Ma1, Guoying Wang1, Fang Xue1, Hui Zhang1, 2, *, #, Weipeng Zhao3, *, #
1Department of Ultrasound, Shanghai Public Health Clinical Center, Shanghai. 200083, China - 2Department of Ultrasound, Zhongshan Hospital, Affiliated Hospital of Fudan University, Shanghai, 200032, China - 3Department of Echocardiography, Zhongshan Hospital, Affiliated Hospital of Fudan University, Shanghai, 200032, China
Introduction: After the outbreak of the Corona Virus Disease 2019 (COVID-19), there have been reports of impaired cardiac function in patients infected with this coronavirus. The tests are mostly based on myocardial injury markers and routine cardiac ultrasound examinations, which are mostly seen in critically ill patients. In this study, two-dimensional speckle tracking imaging (2DSTI) combined with Tei index and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were used to more sensitively diagnose cardiac function impairment in COVID-19 patients.
Materials and methods: For some COVID-19 patients in our hospital, there were 68 cases of mild disease (including mild and common types) and 11 cases of severe disease (4 cases of severe death), and 10 healthy volunteers were included as the control group. On the basis of conventional echocardiography in all subjects, the left ventricular end-diastolic volume (LV-EDV), left ventricular end-systolic volume (LV-ESV), and left ventricular ejection fraction (LV-EF) were obtained by Simpson method, the left ventricular Tei index by tissue Doppler, and the left ventricular global peak longitudinal strain (GLPS), left ventricular global peak radial strain (GRPS), and left ventricular global peak circumferential strain (GCPS) by 2DSTI offline analysis. The COVID-19 patients were subjected to quantitative detection of serum NT-proBNP for statistical analysis.
Results: Left ventricular GLPS, left ventricular GRPS, and left ventricular GCPS in COVID-19 patients were significantly lower than those in the control group (P<0.05): The left ventricular GLPS was more significant (P<0.01), and the severe group (including the death group) < the mild group < the control group. The left ventricular Tei index: The severe group (including the death group) of COVID-19 was significantly higher than the mild group and the control group (P<0.05), and there was no statistical significance between the mild group and the control group. NT-proBNP: The severe group of COVID-19 was significantly higher than the mild group (P<0.05). Although the LV-EF in the COVID-19 patients was significantly lower than that in the control group (P<0.05), except for 2 sever cases less than 50%, the rest were all ≥50%; although there was a significant difference in LV-ESV among multiple groups (P<0.05), but there was no significant difference for the pairwise comparison, and there was no significant difference in LV-EDV.
Conclusion: 2DSTI can more sensitively detect latent cardiac function impairment in COVID-19 patients, and the left ventricular GLPS is the most sensitive. Tei index is an effective indicator to reflect the degree of cardiac function impairment. NT-proBNP has significant significance in predicting the severity of cardiac dysfunction. The combined application of the three can significantly increase the predictive performance of cardiac function impairment, provide a diagnostic basis for cardiac function impairment with preserved ejection fraction, and predict the degree of impairment. Our study demonstrated that the cardiac function of COVID-19 patients is impaired to varying degrees.
2DSTI, Tei index, NT-proBNP, COVID-19 patients, left ventricular function.