J Korean Med Sci.  2020 Oct;35(40):e366. 10.3346/jkms.2020.35.e366.

Cardiac Manifestations of Coronavirus Disease 2019 (COVID-19): a Multicenter Cohort Study

• Kim M
• Nam JH
• Son JW
• Kim SO
• Son NH
• Ahn CM
• Shim CY
• Hong GR
• Kim IC
• Choi J
• Kang SM
• Choi YH
• Yoon HK
• Uhm JS
• Jung IH

• KMID: 2507620
• DOI: http://doi.org/10.3346/jkms.2020.35.e366

Abstract

Background
This study aimed to investigate the cardiac manifestations of coronavirus disease 2019 (COVID-19).
Methods
From February to March 2020, we prospectively and retrospectively enrolled consecutive patients diagnosed with COVID-19. Patient's data such as the demographic characteristics, symptoms, vital signs, laboratory and radiologic findings, electrocardiographic, and echocardiographic data, including the global longitudinal strain (GLS) of both ventricles, were obtained.
Results
Forty patients (median age, 58 years; 50% men) were enrolled in the initial analysis. Patients were classified into severe and nonsevere groups based on the current guidelines. The 13 patients in the severe group were significantly older, had a greater prevalence of bilateral pneumonia and leukocytosis, and higher aspartate transaminase levels than patients in the nonsevere group. Patients in the severe group had a slightly lower left ventricular ejection fraction (LVEF) than those in the nonsevere group (median [interquartile range], 61.0% [58.5%, 62.3%] vs. 66.7% [60.6%, 69.8%], P = 0.015). In a subgroup of 34 patients in whom GLS could be analyzed, patients in the severe group had a significantly impaired left ventricular GLS (LVGLS) than those in the nonsevere group (−18.1% [−18.8%, −17.1%] vs. −21.7% [−22.9%, −19.9%], P = 0.001). There were no significant differences in total wall (RVGLS total , −19.3% [−23.9%, −18.4%] vs. −24.3% [−26.0%, −22.6%], P = 0.060) and free wall (RVGLS fw , −22.7% [−27.2%, −18.6%] vs. −28.8% [−30.4%, −24.1%], P = 0.066) right ventricle GLS (RVGLS).
Conclusion
Patients with severe COVID-19 had lower LVEF and LVGLS. RVGLS was not different between patients with severe and nonsevere COVID-19.

Keyword

Coronavirus; COVID-19; Echocardiography; Global Longitudinal Strain; Ejection Fraction; Disease Severity

Figure

• 

  Fig. 1 Left venticicular global longitudinal strain obtained from 2-dimensional speckle tracking echocardiography according to disease severity in coronavirus disease 2019 patients. (A) Representative image of a patient in the severe group; (B) Representative image of a patient in the nonsevere group.LVGLS = left venticicular global longitudinal strain.

• 

  Fig. 2 Echocardiographic parameters of left ventricle according to disease severity in patients with coronavirus disease 2019. (A) LVEF and (B) LVGLS according to disease severity.LVEF = left ventricular ejection fraction, LVGLS = left venticicular global longitudinal strain.

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  Fig. 3 Echocardiographic parameters of right ventricle according to disease severity in patients with coronavirus disease 2019. (A) RVGLStotal and (B) RVGLSfw according to disease severity.RVGLStotal = right ventricle global longitudinal strain of including both the free wall and interventricular septum, RVGLSfw = right ventricular free wall global longitudinal strain.

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