Clinical Outcomes and Prognosis

1350433 - Cardiac MRI in Patients with Prior COVID-19 for Assessment of Post-Covid Left Ventricular Myocardial Strain: Correlation with Initial Clinical Severity & Long-Covid Syndrome

Friday, January 27, 2023

9:10 AM – 10:10 AM

Location: Pacific Jewel

Presenting Author(s)

Danielle Toussie, MD

Assistant Professor
New York University Langone Medical Center, United States

Primary Author(s)

Danielle Toussie, MD

Assistant Professor
New York University Langone Medical Center, United States

Co-Author(s)

LA

Lea Azour, MD

Assistant Professor
New York University Langone Medical Center, United States
MF

Mark Finkelstein, MD

Resident Physician
Icahn School of Medicine at Mount Sinai, United States
GV

Geraldine Villasana Gomez, MD

Assistant Professor
New York University Langone Medical Center, United States
WM

William Moore, MD

Professor
New York University Langone Medical Center, United States
JD

Jamie Diamond, MD, MPH

Fellow, Advanced Heart Failure and Transplant Cardiology
Duke University Medical Center, North Carolina, United States
El-sayed H. Ibrahim, PhD

Faculty
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Jadranka Stojanovska, MD, MS

Associate professor
New York University Langone Medical Center
New York, New York, United States

Disclosure(s):

Danielle Toussie, MD: No financial relationships to disclose

El-sayed H. Ibrahim, PhD: No financial relationships to disclose

Jadranka Stojanovska, MD: No financial relationships to disclose

Background: Left ventricular (LV) function quantified by ejection fraction (EF) is typically normal in post-Covid patients on cardiac MRI (CMR)1. While the EF quantifies global LV function, it does not account for regional wall motion abnormalities that may lead to LV remodeling and adverse cardiac events. The relationship between the severity of the initial infection and post-Covid myocardial contractile strain, as a more sensitive measure of impaired LV contractility than EF alone, remains unknown and may augur novel therapeutic strategies to lessen patients’ long-Covid symptoms. The purpose of this study is to determine the effect of initial clinical severity on post-acute global circumference strain (GSC) & global longitudinal strain (GLS), and whether these features are associated with post-Covid symptoms.

Methods: We recruited 74 subjects with a history of Covid from a survivorship registry to undergo 0.55T CMRs between 9/10/2020-8/2/2022: 42 men (57%), median age 55 years [interquartile range (IQR), 41, 63]. Two fellowship trained cardiothoracic imagers calculated LVEF & volume, GCS and GLS using Cvi42 client software. Severity of the subjects initial Covid infection was based on the level of supportive therapy required during the acute illness (outpatient vs hospitalized on any oxygen therapy vs intubated). Review of systems (ROS) included neurological, cardiopulmonary, gastrointestinal and musculoskeletal clusters. Bivariate linear regression was used to evaluate the association between initial clinical parameters, CMR parameters, and post-Covid ROS.

Results:
A total of 36 (49%) subjects were treated outpatient, 25 (34%) hospitalized on oxygen, and 13 (18%) intubated. The median time from Covid diagnosis to CMR was 201 days [IQR 171, 346]. All 74 patients had EF >50% (median 60 [IQR 56, 63]), yet 93% (69/74) had abnormal GCS (reference normal ≥-21.0), and 55% (41/74) had abnormal GLS (reference normal ≥-16.0) (Figure 1).2,3 The mean and standard deviation for GCS and GLS were -17.2 ± 2.6 and -14.9 ± 3.1, respectively. Despite the majority of patients having reduced strain values, there was no statistically significant difference in GCS or GLS in patients requiring higher levels of oxygen supportive therapy during the acute Covid illness (Table 1).
A subset analysis of 43 patients with ROS within 31 days of CMR showed 37 patients (86%) had symptoms. The median time from CMR to ROS was 13 days [IQR -6, 23]. There was no association between any ROS and GCS or GLS (Table 2).

Conclusion: GCS and GLS were reduced in our prospective cohort of patients with prior Covid, yet increasing levels of oxygen supportive therapy during the acute Covid illness did not correlate with myocardial contractile deficit. Myocardial contractile deficit also did not correlate with post-Covid symptoms. A larger sample size with a longitudinal analysis of baseline post-Covid strain and post-Covid symptoms will be presented to provide greater understanding of the myocardial contribution in post-Covid syndrome.