Speckle tracking echocardiography detects subtle right ventricular systolic dysfunction in post Covid syndrome after mild severity Covid-19
Authors: Salem A , Kamel H , Shabana A 
Published: November 2023

Abstract

Introduction
Now that the global COVID-19 pandemic has come to an end, many patients seek medical help for its aftermath giving rise to post COVID syndrome. Post COVID syndrome describes individuals with a history of probable or confirmed COVID-19 infection, usually 3 months from the onset of infection with symptoms that last for at least 2 months and no alternative diagnosis can be explained. The affection of the right ventricular (RV) systolic function is a cornerstone in the pathogenesis underlying Post COVID syndrome. Many modalities were used to assess the RV with a widespread debate as to the most accurate one. However, echocardiography remains the modality of choice for the evaluation of RV systolic function, especially when using its novel features as myocardial deformation imaging by speckle tracking echocardiography (STE) to surpass the RV’s peculiar anatomy, retrosternal position and complex architecture.

Purpose
The aim was to assess RV systolic function by STE 3-6 months after recovery from mild severity COVID-19 disease and correlate these findings with Post COVID syndrome.

Methods
This study included 96 adults (above 18 years of age) who were classified into three equal groups; the first group recruited 32 subjects 3-6 months after recovery from mild severity COVID-19 disease without post COVID syndrome, the second group included 32 subjects 3-6 months after recovery from mild severity COVID-19 disease with post COVID syndrome and the third group recruited 32 gender-matched healthy subjects of similar ages without previous COVID-19 disease (control group). Each subject underwent a detailed transthoracic echocardiography including RV function assessment using 2D RV STE imaging.

Results
RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) were significantly lower in patients after recovery from mild severity COVID-19 disease with post COVID syndrome (P-value= 0.010) in comparison to the other groups. There was a statistically significant negative correlation found between RV 2D STE parameters and RV end-diastolic dimension, systolic pulmonary artery pressure and RV myocardial performance index. Also, there was a statistically significant positive correlation found between RV 2D STE parameters and RV fractional area change, tricuspid annular plane systolic excursion and RV S'. The cardiac symptomatology in patients with post COVID syndrome was analyzed showing that the most common three symptoms were fatigue, palpitations and chest pain with a prevalence of 65.6%, 40.6% and 31% respectively. These three symptoms showed a significant negative relation with RV-GLS and RV-FWLS.

Conclusion
RV function assessed using STE occupied the lower normal ranges in patients recovering from mild severity COVID-19 disease, particularly those with post COVID syndrome. 2D STE may be used for the detection and follow-up of possible subtle long term RV dysfunction after mild severity COVID-19 disease.RV-GLS and RV-FWLS in the studied groupsRV-GLS and RV-FWLS using 2D STE