Impact of COVID-19 vaccination in post-COVID cardiac complications.

BACKGROUND: After the acute infection, COVID-19 can produce cardiac complications as well as long-COVID persistent symptoms. Although vaccination against COVID-19 represented a clear reduction in both mortality and ICU admissions, there is very little information on whether this was accompanied by a decrease in the prevalence of post-COVID cardiac complications. The aim of this study was to analyze the relationship between COVID-19 vaccination and the prevalence of post-COVID cardiac injury assessed by echocardiogram, and long-COVID persistent cardiac symptoms. METHODS: All patients who consulted for post-COVID evaluation 14 days after discharge from acute illness were included. Patients with heart disease were excluded. The relationship between complete vaccination scheme (at least two doses applied with 14 days or more since the last dose) and pathological echocardiographic findings, as well as the relationship of vaccination with persistent long-COVID symptoms, were evaluated by multivariate analysis, adjusting for age, sex and clinical variables that would have shown significant differences in univariate analysis. RESULTS: From 1883 patients, 1070 patients (56.8%) suffered acute COVID-19 without a complete vaccination scheme. Vaccination was associated with lower prevalence of cardiac injury (1.35% versus 4.11%, adjusted OR 0.33; 95% CI 0.17-0.65, p=0.01). In addition, vaccinated group had a lower prevalence of persistent long-COVID symptoms compared to unvaccinated patients (10.7% versus 18.3%, adjusted OR 0.52; 95% CI 0.40-0.69, p<0.001). CONCLUSION: Vaccination against COVID-19 was associated with lower post-COVID cardiac complications and symptoms, reinforcing the importance of fully vaccinating the population.

Injuria cardíaca post- COVID19 y su relación con la gravedad del cuadro agudo, los síntomas persistentes y la vacunación / Cardiac Injury after COVID-19 and its Association with the Severity of the Acute Presentation, Persistent Symptoms and Vaccination

RESUMEN Introducción: La infección por COVID-19 se asocia a compromiso cardiovascular en su etapa aguda. La información sobre el compromiso cardíaco post-COVID es muy heterogénea, y la indicación de realizar estudios de imágenes cardíacas de forma rutinaria es aún controvertida. Asimismo, no existe información actualizada sobre el efecto que produjo la vacunación masiva en la incidencia de la injuria cardíaca post-COVID. Objetivos: Analizar la prevalencia de injuria cardíaca mediante ecocardiograma luego de la infección por COVID-19 y su asociación con la gravedad del cuadro agudo y con los síntomas persistentes post-COVID. Como objetivo secundario se exploró la relación de la prevalencia de injuria cardíaca con el inicio de la campaña de vacunación contra COVID-19 en la República Argentina. Material y métodos: Estudio analítico, observacional, prospectivo y unicéntrico. Se incluyeron todos los pacientes consecutivos que consultaron para realizar evaluación post-COVID. Se realizó ecocardiograma transtorácico en todos los pacientes. Se consideró la fecha de inicio de la campaña de vacunación (29/12/2020) para el análisis de los subgrupos pre y post vacunación. Resultados: Se incluyeron los primeros 1000 pacientes que consultaron al centro desde el 01/09/2020 al 01/09/2021. Treinta y nueve (3,9%) presentaron hallazgos patológicos en el ecocardiograma compatibles con injuria post-COVID, incluyendo disfunción ventricular izquierda (2,8%), derrame pericárdico (0,5%) y trastorno de motilidad parietal (0,6%), no conocidos previamente. Los pacientes que padecieron cuadros de COVID-19 agudo moderados o graves presentaron mayor prevalencia de trastornos de motilidad parietal (2,9% versus 0,3%, p = 0,001) y derrame pericárdico (2,9% versus 0,14%, p = 0,001) en comparación con aquellos con cuadros asintomáticos o leves, y esta asociación se mantuvo al ajustar por factores de riesgo cardiovascular y edad (OR 6,7; IC 95% 1,05-42,2, p = 0,04 y OR 25,1; IC 95% 2,1-304,9, p = 0,01 respectivamente). El 19,3% de los pacientes referían síntomas persistentes en la consulta post-COVID; en estos pacientes se observó mayor evidencia de disfunción ventricular izquierda nueva (8,3% vs 2,4%, p<0,005); no obstante, dicha asociación perdió significancia en el análisis multivariado. Respecto a la relación de la injuria cardíaca con el inicio de la vacunación, los 330 pacientes que se realizaron estudios de control post-COVID previamente al inicio de la campaña presentaron mayor prevalencia de injuria que los 670 pacientes luego de esta fecha (6,3% vs 2,7%, p = 0,006). Esta relación se mantuvo en el análisis multivariado (OR 0,35; IC95% 0,17-0,69). Conclusión: La prevalencia de injuria cardíaca evaluada mediante ecocardiograma luego de la infección por COVID-19 fue de 3,9%. Se observó una asociación significativa e independiente entre cuadros iniciales de mayor gravedad y hallazgos patológicos en el ecocardiograma en la etapa post-COVID, no así con los síntomas persistentes. Los pacientes que consultaron luego del inicio de la campaña de vacunación en Argentina presentaron menos prevalencia de injuria cardíaca en comparación con los pacientes de la primera ola.

ABSTRACT Background: COVID-19 is associated with cardiovascular involvement in the acute phase. The information about cardiac involvement after COVID-19 is heterogeneous, and the indication to routinely perform cardiac imaging tests is still controversial. There is no updated information on the effect mass vaccination has on the incidence of cardiac injury after COVID-19. Objectives: The primary objective of this study was to evaluate the prevalence of cardiac injury after COVID-19 by transthoracic echocardiography and its association with the severity of the acute phase and with persistent symptoms after recovery. The secondary objective was to explore the association of the prevalence of cardiac injury with the beginning of the vaccination campaign against COVID-19 in Argentina. Methods: We conducted an observational, single-center, and retrospective study. All the consecutive patients who consulted for post-COVID-19 evaluation were included. All the patients underwent transthoracic echocardiography. The date the vaccination campaign started (12/29/2020) was considered the cut-off point for the analysis of the pre-vaccination and postvaccination subgroups. Results: The first 1000 patients who consulted in our center between 09/01/2020 and 09/01/2021 were included. Thirty-nine patients (3.9%) had new abnormal echocardiographic findings suggestive of cardiac injury after COVID-19, including left ventricular dysfunction (2.8%), pericardial effusion (0.5%), and wall motion abnormalities (0.6%). Patients with moderate or severe acute COVID-19 presented a higher prevalence of wall motion abnormalities (2.9% versus 0.3%, p= 0.001) and pericardial effusion (2.9% versus 0.14%, p = 0.001) compared to those with asymptomatic or mild COVID-19 and this association remained after adjusting for cardiovascular risk factors and age (OR 6.7, 95% CI 1.05-4.2, p = 0.04, and OR 25.1, 95% 2.1-304.9, p = 0.01 respectively). The percentage of patients who reported persistent symptoms during consultation after COVID-19 was 19.3%, and they had higher evidence of new left ventricular dysfunction (8.3% vs. 2.4%, p < 0.005); however, this association lost significance on multivariate analysis. When the association of cardiac injury with the start of vaccination was considered, the 330 patients who underwent post-COVID assessment before the vaccination campaign started had a higher prevalence of injury than the 670 patients evaluated after this date (6.3% vs. 2.7%, p = 0.006). and this association persisted on multivariate analysis (OR 0.35; 95%CI 0.17-0.69). Conclusion: The prevalence of cardiac injury assessed by echocardiography after COVID-19 was 3.9%. There was a significant and independent association between the severe initial presentations and the abnormal echocardiographic findings after COVID-19, but not with persistent symptoms. Patients who consulted after the vaccination campaign started in Argentina had a lower prevalence of cardiac injury compared with those patients in the first wave.

Compromiso cardíaco y su relación con la gravedad del cuadro agudo y los síntomas persistentes en la convalecencia de infección por COVID-19 / Cardiovascular Involvement and its Relationship with the Severity of the Acute Phase and Persistent Symptoms during Recovery from COVID-19 Infection

RESUMEN Introducción: La infección por COVID-19 se asocia a compromiso cardiovascular en su etapa aguda. La información sobre el compromiso cardíaco en la etapa de convalecencia de la enfermedad tanto en pacientes con y sin síntomas persistentes es limitada. Objetivos: 1. Analizar el compromiso cardíaco mediante ecocardiograma en la etapa de convalecencia de la enfermedad por COVID-19; 2. Explorar su asociación con: a) gravedad del cuadro agudo y b) persistencia de síntomas. Métodos: Estudio analítico, observacional, prospectivo y unicéntrico. Se incluyeron pacientes consecutivos que consultaron al centro para realizar evaluación post-COVID. Se realizó ecocardiograma Doppler color transtorácico en busca de hallazgos patológicos. Resultados: Se incluyeron 600 pacientes desde el 01/09/2020 al 01/05/2021. Veintinueve (4,8%) presentaron hallazgos patológicos en el ecocardiograma. Los pacientes con cuadros iniciales moderados o graves presentaron mayor prevalencia de trastornos de motilidad parietal (4,3% versus 0,5%, p = 0,02) y derrame pericárdico (4,3% versus 0,24%, p = 0,01) en comparación con aquellos con cuadros asintomáticos o leves. En el ajuste multivariado esta asociación no alcanzó significación estadística. El 28,6% de los pacientes referían síntomas persistentes, no observándose una asociación entre la presencia de los mismos y los hallazgos ecocardiográficos patológicos. Conclusión: La prevalencia de compromiso cardíaco evaluado mediante ecocardiograma en la etapa de convalecencia de la enfermedad por COVID-19 fue de 4,8%. Los pacientes con cuadros iniciales más graves presentaron más hallazgos patológicos. La significancia no se sostuvo en el análisis multivariado. Los síntomas persistentes no se asociaron a mayor compromiso cardíaco.

ABSTRACT Background: The acute phase of COVID-19 infection is associated with cardiovascular involvement, but there is limited information regarding this relationship in the recovery phase from this disease both in patients with or without persistent symptoms. Objectives: The aims of this study were: 1. To analyze cardiovascular involvement by echocardiography in the recovery phase from COVID-19 disease, and 2. To explore its association with: a) the severity of the acute phase and b) the presence of persistent symptoms. Methods: An analytical, observational, prospective and single-center study was carried out, including consecutive patients attending the center for post-COVID-19 evaluation who underwent a transthoracic color Doppler echocardiogram looking for pathological outcomes. Results: A total of 600 patients were included from September 1, 2020 to May 1, 2021, and 29 of these patients (4.8%) presented pathological findings in the echocardiogram. Patients with moderate or severe acute phase COVID-19 infection had a higher prevalence of wall motion disorders (4.3% vs. 0.5%, p=0.02) and pericardial effusion (4.3% vs. 0.24%, p=0.01) compared with those with asymptomatic or mild symptoms; however, after multivariate adjustment, this association did not reach statistical significance. In 28.6% of cases, patients reported persistent symptoms, with no evident association between their presence and pathological echocardiographic results. Conclusion: The prevalence of cardiovascular involvement evaluated by echocardiography was 4.8% in the recovery phase from COVID-19 disease. Patients with more severe initial clinical presentation exhibited more pathological findings, but the significance was not sustained in the multivariate analysis. Persistent symptoms were not associated with greater cardiovascular involvement.