Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study
Abstract Usual clinical testing rarely reveals cardiac abnormalities persisting after hospitalization for COVID. Such testing may overlook residual changes causing increased adverse cardiac events post‐discharge. To clarify status post‐hospitalization, we related exercise stress echocardiography (ES...
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Wiley
2024-12-01
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| Series: | Physiological Reports |
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| Online Access: | https://doi.org/10.14814/phy2.70138 |
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| author | Robert E. Goldstein Edward A. Hulten Thomas B. Arnold Victoria M. Thomas Andrew Heroy Erika N. Walker Keiko Fox Hyun Lee Joya Libbus Bethelhem Markos Maureen N. Hood Travis E. Harrell Mark C. Haigney |
| author_facet | Robert E. Goldstein Edward A. Hulten Thomas B. Arnold Victoria M. Thomas Andrew Heroy Erika N. Walker Keiko Fox Hyun Lee Joya Libbus Bethelhem Markos Maureen N. Hood Travis E. Harrell Mark C. Haigney |
| author_sort | Robert E. Goldstein |
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| description | Abstract Usual clinical testing rarely reveals cardiac abnormalities persisting after hospitalization for COVID. Such testing may overlook residual changes causing increased adverse cardiac events post‐discharge. To clarify status post‐hospitalization, we related exercise stress echocardiography (ESE) in 15 recovering patients (RP) age 30–63 without myocarditis to matching published data from healthy subjects (HS). RP exercise, average duration 8.2 ± 2.2 SD, was halted by dyspnea or fatigue. RP baselines matched HS except for higher heart rate. At peak stress, RP had significantly lower mean left ventricular (LV) ejection fraction (67% ± 7 vs. 73% ± 5, p < 0.0017) and higher peak early mitral inflow velocity/early mitral annular velocity (E/e’, 9.1 ± 2.5 vs. 6.6 ± 2.5, p < 0.006) compared with HS performing equal exercise (8.5 ± 2.6 min). Thus, when stressed, patients without known cardiac impairment showed diminished systolic contractile function and diastolic LV compliance vs. HS. RP peak heart rate was significantly higher (172 ± 18 vs. 153 ± 20); peak systolic blood pressure trended higher (192 ± 31 vs. 178 ± 19). Pulmonary artery systolic pressures among RP remained normal. ESE uniquely identified residual abnormality in cardiac contractile function not evident unstressed, exposing previously unrecognized residual influence of COVID‐19. This may reflect autonomic dysfunction, microvascular disease, or diffuse interstitial changes; these results may have implications for clinical management and later prognosis. |
| format | Article |
| id | doaj-art-7f704e2e28bd447a9685daeecc4b9d60 |
| institution | Kabale University |
| issn | 2051-817X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Physiological Reports |
| spelling | doaj-art-7f704e2e28bd447a9685daeecc4b9d602025-01-10T11:14:29ZengWileyPhysiological Reports2051-817X2024-12-011223n/an/a10.14814/phy2.70138Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot studyRobert E. Goldstein0Edward A. Hulten1Thomas B. Arnold2Victoria M. Thomas3Andrew Heroy4Erika N. Walker5Keiko Fox6Hyun Lee7Joya Libbus8Bethelhem Markos9Maureen N. Hood10Travis E. Harrell11Mark C. Haigney12Military Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAWalter Reed National Military Medical Center Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAWalter Reed National Military Medical Center Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USADepartment of Radiology Uniformed Services University of the Health Sciences Bethesda Maryland USAWalter Reed National Military Medical Center Bethesda Maryland USAMilitary Cardiovascular Outcomes Research Program Uniformed Services University of the Health Sciences Bethesda Maryland USAAbstract Usual clinical testing rarely reveals cardiac abnormalities persisting after hospitalization for COVID. Such testing may overlook residual changes causing increased adverse cardiac events post‐discharge. To clarify status post‐hospitalization, we related exercise stress echocardiography (ESE) in 15 recovering patients (RP) age 30–63 without myocarditis to matching published data from healthy subjects (HS). RP exercise, average duration 8.2 ± 2.2 SD, was halted by dyspnea or fatigue. RP baselines matched HS except for higher heart rate. At peak stress, RP had significantly lower mean left ventricular (LV) ejection fraction (67% ± 7 vs. 73% ± 5, p < 0.0017) and higher peak early mitral inflow velocity/early mitral annular velocity (E/e’, 9.1 ± 2.5 vs. 6.6 ± 2.5, p < 0.006) compared with HS performing equal exercise (8.5 ± 2.6 min). Thus, when stressed, patients without known cardiac impairment showed diminished systolic contractile function and diastolic LV compliance vs. HS. RP peak heart rate was significantly higher (172 ± 18 vs. 153 ± 20); peak systolic blood pressure trended higher (192 ± 31 vs. 178 ± 19). Pulmonary artery systolic pressures among RP remained normal. ESE uniquely identified residual abnormality in cardiac contractile function not evident unstressed, exposing previously unrecognized residual influence of COVID‐19. This may reflect autonomic dysfunction, microvascular disease, or diffuse interstitial changes; these results may have implications for clinical management and later prognosis.https://doi.org/10.14814/phy2.70138COVID‐19left ventricular dysfunctionstress echocardiography |
| spellingShingle | Robert E. Goldstein Edward A. Hulten Thomas B. Arnold Victoria M. Thomas Andrew Heroy Erika N. Walker Keiko Fox Hyun Lee Joya Libbus Bethelhem Markos Maureen N. Hood Travis E. Harrell Mark C. Haigney Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study Physiological Reports COVID‐19 left ventricular dysfunction stress echocardiography |
| title | Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study |
| title_full | Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study |
| title_fullStr | Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study |
| title_full_unstemmed | Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study |
| title_short | Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study |
| title_sort | exercise stress echocardiography shows impaired left ventricular function after hospitalization with covid 19 without overt myocarditis a pilot study |
| topic | COVID‐19 left ventricular dysfunction stress echocardiography |
| url | https://doi.org/10.14814/phy2.70138 |
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