Structural and functional remodeling of the heart in hypertensive patients with COVID-19: assessmentof changes at the end of hospitalization period and during a 1-month follow-up

Abstract

COVID-19 is often accompanied by the long-term persistence of symptoms, the risk of which depends on the severity and duration of the acute phase, as well as existing comorbidities. Cardiac dysfunction is one of the possible mechanisms of impaired functional status of patients. While clinically manifest systolic heart failure is a rare phenomenon in such a situation, minor alterations in the structural and functional state of the heart may be contributing to persistence of general symptoms such as dyspnea, fatigue, and reduced work capacity.
The aim – to study the role of hypertension in the formation of structural and functional changes of the heart during hospitalization for COVID-19, and the dynamics of detected changes in the early period after discharge.
Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % female) underwent a comprehensive transthoracic echocardiographic examination 1-2 days before discharge and after 31 days of follow-up. The control group included 88 subjects matched by age, sex, height, weight, and existing comorbidities. The studied parameters included morphometry of the cardiac chambers, indices of longitudinal systolic function and diastolic filling of the ventricles; the participants were also performing a 6-minute walk test.
Results. Geometric changes of the heart in hospitalized patients with COVID-19 at the time of discharge included an increase in absolute (10.1±1.5 vs 9.1±0.9 mm, p<0.001) and relative LV walls thickness (0.45±0,07 vs 0.39±0.04, p<0.001), indices of LV myocardial mass (38.1±8.9 vs 33.9±5.8 g/m^2.7, p<0.001) and left atrial volume index (28.6±6.6 vs 25.1±4.9 ml/m², p<0.001), as well as a decrease in LV global longitudinal strain (-17.5±2.4 vs -18.6±2.2 %, p<0.001) and diastolic filling parameters (e’ – 9.2±2.2 vs 11.3±2.6 cm/s, p<0.001; E/e’ – 7.5±1.8 vs 6.8±1.7, p=0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted in normotensive patients, resulting in a high prevalence of concentric LV geometry (78 % and 43 %, respectively, p<0.001 between groups and vs controls), mainly type I diastolic dysfunction (51 % and 25 %, p<0.001 between groups and vs control), as well as abnormal values of global longitudinal strain (32 % and 19 %, p=0.027 between groups, p<0.001 vs control), which persisted during a short observation period. The increase in the reached % of individually predicted 6-minute walk distance was 11.2±7.5 in hypertensive participants vs 12.8±7.6 in normotensives, p>0.05.
Conclusions. Patients with COVID-19 at the end of hospitalization period were characterized by a high prevalence of LV concentric geometry and diastolic dysfunction, as well as minor decrease in its longitudinal systolic function, which were more pronounced in the presence of concomitant hypertension and did not improve during the first month after discharge.