Myocardial Dysfunction Shown with Global Longitudinal Strain Imaging in COVID-19 Patients

Background: The incidence of acute cardiac injury in coronavirus disease 2019 (COVID-19) patients has been reported to range between 8–28% The aim of our case-series study was to describe the 2D echocardiography, Doppler and myocardial strain findings of hospitalized COVID-19 patients based on echocardiographic features Methods: We performed a search of COVID-19 patients admitted to our institution from November 1st, 2019 to June 8th, 2020 All available transthoracic echocardiograms (TTE) were reviewed and off-line assessment of left ventricular global longitudinal strain (GLS) was performed We also analyzed electrocardiograms (ECG) and laboratory findings including inflammatory markers that were described as indicators for COVID-19 severity Findings: Out of 1034 patients admitted with COVID-19, 60 (5 8%%) underwent TTE while hospitalized LVEF was reduced and wall motion abnormalities were found in 13 (22%) of these patients and increased LV wall thickness was present in 53% (mean for combined posterior wall and inter ventricular septum 2 61cm±1 53, normal range 2 2cm) Patients with reduced systolic function had low stroke volume (mean LVOT-VTI 16 6 cm, normal range 20-30cm) Left ventricular GLS analysis was available for 40 patients and revealed reduced peak left ventricular longitudinal strain in 80% of them (mean -12 16%±4 01) All patients with LV dysfunction had elevated levels of cardiac and inflammatory biomarkers Interpretation: Our case-series study found that LV dysfunction as detected by reduced EF and segmental wall motion abnormalities is present in less than 25% of hospitalized COVID-19 patients However, signs of subclinical myocardial dysfunction by GLS is quite prevalent, occurring in 80% of patients The mechanism of cardiac injury and/or dysfunction in COVID-19 infection remains uncertain Potential etiologies may include myocarditis, systemic cytokine-mediated injury, microvascular injury or stress-related cardiomyopathy Funding: There was no extra-mural funding for this study Declaration of Interests: There are no author disclosures of financial relationships with industry relevant to this study Ethics Approval Statement: The Cedars-Sinai Institutional Review Board has approved this study protocol and waived the requirement for individual written consent