Predictors of Reduced Left Ventricle Global Longitudinal Strain One Year After COVID-19 Pneumonia.

Aim      To identify predictors of decreased left ventricular global longitudinal strain (LV GLS) using the method of speckle-tracking in gray scale one year after COVID-19-associated pneumonia in patients without ischemic heart disease (IHD), previous pulmonary embolism (PE), peripheral thrombosis, and atrial fibrillation (AF).Material and methods  The study included 156 patients from the Prospective Registry of People After COVID-19-Associated Pneumonia, with optimal visualization quality according to echocardiography (EchoCG), without IHD, AF, history of pulmonary embolism (PE), and peripheral thrombosis. The patients underwent clinical examination in the hospital during the acute period and at 3 and 12 months after discharge from the hospital. To identify earlier predictors of LV GLS impairment, clinical, laboratory, and instrumental data obtained in the hospital and at 3 months of discharge were compared based on the presence of LV GLS impairment one year after discharge (43 patients with reduced LV GLS and 113 patients with normal LV GLS). An LV GLS value ≥18% was considered reduced.Results At 3 months after discharge from the hospital, LV GLS impairment was detected in 34 (21.8%) of 156 patients, and 12 months later, in 43 (27.6%; p=0.211) of 156 patients. In contrast to the group with normal LV GLS, the majority of the group with reduced LV GLS were men (74.4% vs. 37.2%; p=0.001). In this group, body mass index (BMI) was significantly higher (29.9±4.3 kg/m2 vs. 28.1±4.5 kg/m2; p=0.011), and biological (11.6% vs. 2.7%; p=0.024) and hormonal therapy was administered more frequently (38.1% vs. 22.3%; p=0.049). The final predictive model for LV GLS impairment included male gender (odds ratio (OR), 5.65; 95% confidence interval (CI), 1.22-14.37; p <0.001), BMI (OR, 1.11; 95% CI, 1.01-1.23; p=0.040), left ventricular end-systolic volume index (LVESVI) (OR, 1.10; 95% CI, 1.01-1.22; p=0.046) and right ventricular outflow tract (RVOT) acceleration time (OR, 0.98; 95% CI, 0.95-0.99; p=0.027).Conclusion      One year after COVID-19-associated pneumonia, a decrease in LV GLS was observed in 27.6% of patients without IHD, AF, history of PE, and peripheral thrombosis and was associated with male gender, increased BMI and LVESVI, and shortened RVOT acceleration time as measured 3 months after discharge from the hospital. The decrease in LV GLS one year after discharge was not associated with the severity of the disease, length of stay in the hospital, or biological and hormonal therapy.

Hidden systolic dysfunction of the right ventricle in patients with increased pulmonary vascular resistance 3 months after COVID-19 pneumonia.

Aim      To study the relationship of echocardiographic right ventricular (RV) structural and functional parameters and indexes of pulmonary vascular resistance (PVR) in patients 3 months after COVID-19 pneumonia.Material and methods  This cross-sectional, observational study included 96 patients aged 46.7±15.2 years. The inclusion criteria were documented diagnosis of COVID-19-associated pneumonia and patient's willing to participate in the observation. Patients were examined upon hospitalization and during the control visit (at 3 months after discharge from the hospital). Images and video loops were processed, including the assessment of myocardial longitudinal strain (LS) by speckle tracking, according to the effective guidelines. The equation [tricuspid regurgitation velocity/ time-velocity integral of the RV outflow tract × 10 + 0.16] was used to determine PRV. Patients were divided into group 1 (n=31) with increased PRV ≥1.5 Wood units and group 2 (n=65) with PRV <1.5 Wood units.Results At baseline, groups did not differ in main clinical functional characteristics, including severity of lung damage by computed tomography (32.7±22.1 and 36.5±20.4 %, respectively. р=0.418). Echocardiographic linear, planimetric and volumetric parameters did not significantly differ between the groups. In group 1 at the control visit, endocardial LS of the RV free wall (FW) (-19.3 [-17.9; -25.8] %) was significantly lower (р=0.048) than in group 2 (-23.4 [-19.8; -27.8] %), and systolic pulmonary artery pressure (sPAP) according to C. Otto (32.0 [26.0; 35.0] mm Hg and 23.0 [20.0; 28.0] mm Hg) was significantly higher than in group 2 (р<0.001). According to the logistic regression, only endocardial RV FW LS (odds ratio, OR, 0.859; 95 % confidence interval, CI, 0.746-0.989; р=0.034) and sPAP (OR, 1.248; 95 % CI, 1.108-1405; р<0.001) were independently related with the increase in PVR. Spearman correlation analysis detected a moderate relationship between PVR and mean PAP according to G. Mahan (r=0.516; p=0.003) and between PVR and the index of right heart chamber functional coupling with the PA system (r=-0.509; p=0.007) in group 1 at the control visit.Conclusion      In patients 3 months after COVID-19 pneumonia, hidden RV systolic dysfunction defined as depressed endocardial RV FW LS to -19.3% is associated with increased PVR ≥1.5 Wood units.

Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge.

Aim    To study changes in clinical and echocardiographic parameters in patients after documented COVID-19 pneumonia at 3 months and one year following discharge from the hospital. Material and methods    The study included 116 patients who have had documented COVID-19 pneumonia. Patients underwent a comprehensive clinical evaluation at 3 months ± 2 weeks (visit 1) and at one year ± 3 weeks after discharge from the hospital (visit 2). Mean age of the patients was 49.0±14.4 years (from 19 to 84 years); 49.6 % were women. Parameters of global and segmentary longitudinal left ventricular (LV) myocardial strain were studied with the optimal quality of visualization during visit 1 in 99 patients and during visit 2 in 80 patients.Results    During the follow-up period, the incidence rate of cardiovascular diseases (CVD) increased primarily due to development of arterial hypertension (AH) (58.6 vs. 64.7 %, р=0.039) and chronic heart failure (CHF) (35.3% vs. 40.5 %, р=0.031). Echocardiography (EchoCG) showed decreases in values of end-diastolic dimension and volume, LV end-systolic and stroke volumes (25.1±2.6 vs. 24.5±2.2 mm /m2, p<0.001; 49.3±11.3 vs. 46.9±9.9 ml /m2, p=0.008; 16.0±5.6 vs. 14.4±4.1 ml /m2, p=0.001; 36.7±12.8 vs. 30.8±8.1 ml /m2, p<0.001, respectively). LV external short-axis area (37.1 [36.6-42.0] vs. 38.7 [35.2-43.1] cm2, р=0.001) and LV myocardial mass index calculated with the area-length formula (70.0 [60.8-84.0] vs. 75.4 [68.2-84.9] g /m², р=0.024) increased. LV early diastolic filling velocity (76.7±17.9 vs. 72.3±16.0 cm /sec, р=0.001) and lateral and septal early diastolic mitral annular velocities decreased (12,10±3,9 vs. 11.5±4.1 cm /sec, р=0.004 and 9.9±3.3 vs. 8.6±3.0 cm /sec, р<0.001, respectively). The following parameters of LV global longitudinal (-20.3±2.2 vs. -19.4±2.7 %, р=0.001) and segmental strain were impaired: apical segments (anterior, from -22.3±5.0 to -20.8±5.2 %, р=0.006; inferior, from -24.6±4.9 to -22.7±4.6, р=0.003; lateral, from -22.7±4.5 to -20.4±4.8 %, р<0.001; septal, from -25.3±4.2 to -23.1±4.4 %, р<0.001; apical, from -23.7±4.1 to -21.8±4.1 %, р<0.001), mid-cavity (anteroseptal, from -21.1±3.3 to -20.4±4.1 %, р=0.039; inferior, from -21.0±2.7 to -20.0±2.9 %, р=0.039; lateral, from -18.4±3.7 to -17.6±4.4 %, р=0.021). RV basal and mid-cavity sphericity indexes increased (0.44±0.07 vs. 0.49±0.07 and 0.37±0.07 vs. 0.41±0.07, respectively, р<0.001 for both). A tendency for increased calculated pulmonary arterial systolic pressure (22.5±7.1 and 23.3±6.3 mm Hg, р=0.076) was observed. Right ventricular outflow tract velocity integral decreased (18.1±4.0 vs. 16.4±3.7 cm, р<0.001).Conclusion    Patients after COVID-19 pneumonia one year after discharge from the hospital, compared to the follow-up data 3 months after the discharge, had an increased incidence of CVD, primarily due to the development of AH and CHF. EchoCG revealed changes in ventricular geometry associated with impairment of LV diastolic and systolic function evident as decreases in LV global longitudinal strain and LV myocardial apical and partially mid-cavity strain.

The level of growth differentiation factor 15 as a predictor of left atrial thrombosis in patients with nonvalvular atrial fibrillation.

Aim    To study the role of blood concentration of growth differentiation factor 15 (GDF-15) as a predictor of left atrial/left atrial appendage (LA/LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF).Material and methods    538 patients with nonvalvular AF were admitted to the Tyumen Cardiology Research Center in 2019-2020 for radiofrequency ablation and elective cardioversion. According to findings of transesophageal echocardiography (EcoCG), 42 (7.8%) of these patients had LA/LAA thrombosis and 79 (14.7%) of them had the effect of spontaneous echo contrast (SEC). This comparative, cross-sectional, cohort study included at the initial stage 158 successively hospitalized patients with nonvalvular AF: group 1 (with LA/LAA thrombosis, n=42) and group 2 (without LA/LAA thrombosis and without SEC, n=116). To eliminate significant differences in age between the groups, an additional inclusion criterium was introduced, age from 45 to 75 years. Finally, 144 patients were included into the study: group 1 (with LA/LAA thrombosis, n=42, mean age 60.9±7.2 years) and group 2 (without LA/LAA thrombosis and without SEC, n=116, mean age 59.5±6.0 years). 93 (91%) patients in group 1 and 40 (95%) patients in group 2 had arterial hypertension (p=0.4168); 53 (52%) and 29 (^(%), respectively, had ischemic heart disease (p=0.0611). The groups did not differ in sex, profile of major cardiovascular diseases, or frequency and range of oral anticoagulant treatment. General clinical evaluation, EchoCG, and laboratory tests, including measurements of blood concentrations of GDF-15 and NT-proBNP, were performed.Results    In the group with LA/LAA thrombosis, 1) persistent AF prevailed whereas paroxysmal AF was more frequently observed in patients without thrombosis; 2) a tendency toward more pronounced chronic heart failure was observed; 3) tendencies toward a high median CHA2DS2­VASc score and toward a greater proportion of patients with scores ≥3 were observed. According to EchoCG findings, group 1 had higher values of sizes and volumes of both atria and the right ventricle, left ventricular (LV) end-systolic volume and size, pulmonary artery systolic blood pressure, and LV myocardial mass index. LV ejection fraction (EF) was in the normal range in both groups but it was significantly lower for patients with LA/LAA thrombosis, 59.1±5.1 and 64.0±7.3, respectively (p=0.00006). Concentrations of GDF-15 (p=0.00025) and NT-proBNP were significantly higher in group 1 than in group 2 (p=0.000001). After determining the threshold values for both biomarkers using the ROC analysis, two independent predictors of LA/LAA thrombosis were obtained by the stepwise multiple regression analysis: GDF-15 >935.0 pg/ml (OR=4.132, 95 % CI 1.305-13.084) and LV EF (OR=0.859, 95 % CI 0.776-0.951). The ROC analysis assessed the model quality as good: AUC=0.776 (p<0.001), sensitivity 78.3 %, specificity 78.3 %.Conclusion    For patients with nonvalvular AF, both increased GDF-15 (>935.0 pg/ml) and LV EF are independent predictors for LA/LAA thrombosis.

[The association of growth differentiation factor 15 (GDF-15) level with extent of left atrial fibrosis in patients with nonvalvular atrial fibrillation].

Aim To study the relationship between the serum level of growth differentiation factor 15 (GDF-15) and clinical and functional characteristics and severity of left atrial (LA) fibrosis in patients with nonvalvular atrial fibrillation (AF).Material and methods The study included 87 patients with nonvalvular AF (62 patients with paroxysmal AF and 25 patients with persistent AF) aged 27 to 72 years (mean age, 56.9±9.2 years, 32 women). 85 % of these patients had arterial hypertension (AH), 33 % had AH and ischemic heart disease, and 12.6 % had isolated AF and were hospitalized for primary catheter ablation. General clinical evaluation, echocardiography, laboratory tests including measurement of GDF-15 and NT-proBNP concentrations in blood were performed. As a surrogate substrate of LA fibrosis during the electroanatomical voltage mapping, the area of low-voltage (<0.5 mV) zones in LA was calculated, including the total LA fibrosis area (Sf, cm2) and a percentage of fibrosis of the total LA area (Sf%).Results Median concentration of GDF-15 was 767.5 [590.0; 951.0] pg /ml. The GDF-15 level positively correlated with age, presence and severity of AH and chronic heart failure, body mass index, and degree of obesity, CHA2DS2 VASc score, level of NT-proBNP, and LA fibrosis area (Sf and Sf%) and negatively correlated with the indexes of left ventricular diastolic function, e' septal and e' lateral. The area of fibrosis increased with increasing GDF-15 concentrations divided into quartiles; Sf% exceeded 20 % at GDF-15 levels higher than median. After a comparative analysis of patients with Sf% ≤20 % and >20 %, statistically significantly different variables were included into a stepwise logistic regression analysis. Two independent predictors of LA fibrosis >20% were identified: a concentration of GDF-15 higher than median (odd ratio (OR), 3.318, 95 % confidence interval (CI): 1.184-9.298) and LA volume index (OR, 1.079, 95 % CI: 1.014-1.147). According to results of the ROC analysis, the area under the curve (AUC) was 0.762 (p=0.000), the model specificity was 72.3 %, sensitivity was 72.4 %, and the prediction accuracy was 72.4 %.Conclusion Blood levels of GDF-15 were associated with the presence and severity of major risk factors for AF and the area of LA fibrosis. In this study, a level of GDF-15 above the median and the LA volume index were independent predictors of LA fibrosis > 20% of the LA area.

[Predictors of Left Atrial Severe Fibrosis in Patients with Nonvalvular Atrial Fibrillation].

Objective The search for predictors of severe (>35 %) left atrial (LA) fibrosis in patients (pts) with nonvalvular atrial fibrillation (AF) directed for catheter ablation (CA).Materials and Methods 69 pts with nonvalvular AF (57 paroxismal and 12 persistent) aged from 32 to 69 years (mean age 57.1±8.4, 28 females) were included in the study, among them 59 pts (86 %) with arterial hypertension (AH), 24 (34.8 %) - with AH and CAD. Complete physical study, laboratory tests (including NT-proBNP level), comprehensive echocardiography were performed. As a surrogate substrate of LA fibrosis, the area of low-voltage (<0.5 mV) zones in LA was estimated in the process of voltage electroanatomic mapping, as the first stage of CA. The total square of LA fibrosis in absolute values (Sf, cm2) and in percent of total LA square (Sf%), as well as the degree of fibrosis: degree I - <5 %, II - 5-19 %, III - 20-35 %, IV - >35 % were calculated. Degree IV of fibrosis was considered as severe fibrosis.Results Extent of fibrosis didn't depend on sex, age, body weight, presence of diabetes, CHA2DS2VASc scores, duration of AF history. There was a tendency to smaller Sf in pts with spontaneous termination of AF compared to those who required cardioversion: 7.2 cm2 (4.4; 17.1) and 12.6 cm2 (4.2; 30.5), respectively (p=0.069). Although NT-proBNP level was normal in 62 % of pts (<125 pg / ml), it was higher in Sf% ≥20 % than in Sf% <5 %: 146.0 (48.0; 276.0) and 42.8 (24.2; 91.0) pg / ml, respectively (p=0.0216). The distribution of pts by left ventricular (LV) geometry types was as follows: normal geometry (t.1) - 34, concentric remodeling (t.2) - 16, concentric LV hypertrophy (t.3) - 8, eccentric LV hypertrophy (t.4) - 11. Compared to pts with t. 1 (reference level), pts with t.3 and t.4 had higher LA volume and LV myocardial mass index, and pts with t.4 had larger end-diastolic LV volume and lower LV ejection fraction. Pts with t.4 tended to have higher Sf% than t.1: 31.1 (10.2; 46.2) and 11.2 (5.1; 28.0), respectively (p=0.053). Using logistic regression 3 independent predictors of LA severe fibrosis were detected: type 4 geometry of LV - OR=8.893 (95 % CI 1.150; 68.78), NT-proBNP >128 pg / ml - OR=6.184 (1.01; 37.99), LA volume index >34 ml / m2 - OR=5.92 (1.05; 33.38). According to ROC analysis, the area of the curve AUC = 0.839 (p<0.001), model specificity - 85.1 %, sensitivity - 70.0 %, predictive accuracy - 82.5 %.Conclusion In pts with nonvalvular AF predictors of severe (>35 %) LA fibrosis were LV geometry type in the form of eccentric LV hypertrophy, LA volume index >34 ml / m2 and NT-proBNP >128 pg / ml.