Title : Echocardiographic indicator of longitudinal deformation of the left ventricular myocardial in prediction of myocardial damage in persons with COVID-19
The aim of this study was to establish correlations between myocardial damage (according to the longitudinal deformation index) with biochemical, clinical or radiological parameters in patients of varying severity of COVID-19.
RESEARCH METHODS. The study included 70 people who underwent COVID-19 and are in the period of convalescence. On the GE Vivid S70 device, the index of longitudinal deformity of the left ventricular myocardium (both the entire LV (AFI Avg) and standard scan planes (LAX, A4, A2), as well as isolated basal segments), expressed as a percentage of the initial values ??( the norm is more than -18%). Subsequently, the assessment of correlations of the obtained digital data with the volume of lung tissue damage according to computed tomography (CT) data, with the presence of effusion in the pericardial cavity, as well as with a number of laboratory parameters (ESR, D-dimer level, IL-6) was carried out. Echocardiogram studies were performed on the 25-40th day from the moment of diagnosis.
RESULTS. Registered decrease in AFI Avg in 42.9% of cases (maximum - up to -14.2%, -14.3%, -14.3%, -12.6% in CT-1, 2, 3, 4 groups) should be interpreted as a consequence of coronavirus myocarditis. The average age of patients in the CT-3 and CT-4 groups exceeded those in the CT-1 and CT-2 groups by more than 10 years (60 +\- 10.2 and 58.3 +\- 11.1 versus 46.2 +\- 16.6 and 47.6 +\- 14.2 years, respectively). The maximum negative correlation dependence of the index of longitudinal LV myocardial deformation on age was noted for Avg (r=-1.0, p <0.05), as well as for LAX (r=-0.99), A4 (r=-0.87), A2 (r=-0,72, p> 0.05). AFI values ??in the A4 plane, in the basal segments, as well as the Avg index were the lowest in the CT-3 group (15.2 +\- 2.8%, 11.9 +\- 3.9%, 15.7 +\- 1.4%), which is consistent with the data on the contractility of the LV myocardium, measured by the Simpson method (49.8 +\- 3.3% versus 62.4 +\- 7.7%, 55.8 +\- 5, 9, 58 +\- 8.2% in groups CT-1, 2, 4). At first glance, the situation, paradoxical at first glance, is most likely due to the peculiarities of the treatment tactics, namely, more "aggressive" therapy for patients of the CT-4 group in comparison with patients with a smaller volume of lung damage. All patients in the group with CT-4 lung lesion volume received pulse therapy with steroid drugs, immunosuppressive drugs (tocilizumab, sarilumab, olokizumab), and antiviral drugs (favipiravir).
When assessing the correlations of the studied parameters in the CT-4 group, a negative correlation was found between the index of longitudinal myocardial deformation (in the LAX plane) with the amount of pericardial effusion (r = -0.46), LAX and Avg with the maximum ESR (r = - 0.64 and r = -0.38, respectively). In general, in the COVID-19 group of patients, AFI LAX and Avg indicators had an inverse correlation with the maximum recorded ESR level (r = -0.47 and r = -0.56, respectively), CRP (r = -0.96 and r = -0.98, respectively), with the percentage of lung tissue damage (r = -0.9) and depended on age (r = -1.0, at p <0.05).
CONCLUSION. Myocardial damage in the form of a violation of longitudinal deformity (as an indirect sign of myocarditis) is recorded in 83% of cases in the CT-3 group (2.5 times more often than in the CT-4 group and 1.3 times more often than in the CT-group). 2). These patients are subject to the same intensive care as patients with a lung volume greater than 75%. This approach can lead to better disease outcomes and fewer complications.