Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Cardiac Involvement is the Reason for Persistent Dyspnea in Post COVID-19 Patients without Pulmonary Sequelae: A Retrospective Study
COVID-19 Geçiren Pulmoner Sekeli Olmayan Hastalarda Kalıcı Dispne Nedeni Kardiyak Tutulumdur: Retrospektif Çalışma
Tuğçe ÇÖLLÜOĞLUa, Murat ACATb, Ömer ÖZSARAÇc, Yeşim AKINa, Orhan ÖNALANa
aDepartment of Cardiology, Karabük University Faculty of Medicine, Karabük, Türkiye
bDepartment of Chest Disease, Karabük University Faculty of Medicine, Karabük, Türkiye
cDepartment of Nuclear Medicine, Karabük University Faculty of Medicine, Karabük, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2022;34(2):46-54
doi: 10.5336/cardiosci.2022-88692
Article Language: EN
Full Text
ABSTRACT
 Objective: Several forms of cardiovascular involvement have been described in acute coronavirus disease-2019 (COVID-19) infection and also it has been shown that acute infection is responsible for cardiac symptoms. However, the data on cardiac involvement and associated symptoms in chronic phase remains unclear. Recent evidence have shown that the reason for persistent dyspnea can be persistent cardiac dysfunction in post COVID-19 infection. The aim of our study was to investigate the relationship between persistent dyspnea and cardiac involvement in post COVID19 patients without pulmonary sequelae. Material and Methods: In our study, we recruited 30 post COVID-19 patients with dyspnea between January 2021 and July 2021. In all patients, the absence of pulmonary sequelae was detected with PFT and chest- CT. 2D-TTE, 2DSTE and MPS were performed for each case. Results: Left ventricular dysfunction was detected in 63.3% of patients and also 93.3% of patients had extensive abnormal GLS at 3 month follow-up. Of the patients, 33.3% had myocardial perfusion defect (MPD) and all MPDs were observed to be reversible defects. MPD was obviously seen in anterior wall (60%) and mid (20%) to apical (70%) segments. As compared with patients without MPD, patients with MPD had higher CK-MB (p: 0.016) and troponin I (p: 0.011), lesser PW thickness (p:0.020) and lower peak systolic strain rate at A2C view (p:0.031). Patients with NYHA III had more impaired GLS than patients with NYHA II (p:0.035). Conclusion: Our study suggests ischemic or nonischemic cardiac dysfunction may be associated with persistent dyspnea in post- COVID- 19 patients without lung sequelae.

Keywords: Dyspnea; post-acute COVID-19 syndrome; heart function tests
ÖZET
 Amaç: Akut koronavirüs hastalığı-2019 [coronavirus disease2019 (COVID-19)] enfeksiyonunda çeşitli kardiyovasküler tutulum biçimleri tanımlanmıştır ve ayrıca akut enfeksiyonun kardiyak semptomlardan sorumlu olduğu gösterilmiştir. Bununla birlikte, kronik fazda kardiyak tutulum ve ilişkili semptomlar ile ilgili veriler belirsizliğini korumaktadır. Son kanıtlar, kalıcı dispne nedeninin COVID19 enfeksiyonu sonrası kalıcı kardiyak işlev bozukluğu olabileceğini göstermektedir. Çalışmamızın amacı, COVID-19 sonrası pulmoner sekeli olmayan hastalarda persistan dispne ile kardiyak tutulum arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Çalışmamıza Ocak 2021 ile Temmuz 2021 arasında COVID-19 enfeksiyonu geçiren ve nefes darlığı devam eden 30 hastayı dahil ettik. Tüm hastalarda pulmoner sekel olmadığı SFT ve toraks BT ile tespit edildi. Her hastaya 2D- TTE, 2D- STE ve MPS yapıldı. Bulgular: 3 aylık takipte hastaların %63.3'ünde sol ventrikül disfonksiyonu saptandı ve hastaların %93.3'ünde yaygın anormal GLS vardı. Hastaların %33.3'ünde miyokard perfüzyon defekti (MPD) vardı ve tüm MPD'lerin geri dönüşümlü defekt olduğu gözlendi. MPD en sık olarak ön duvarda (%60) ve orta (%20) ile apikal (%70) segmentlerde görüldü.MPD'i olmayan hastalarla karşılaştırıldığında, MPD'li hastalarda daha yüksek CK-MB (p: 0.016) ve troponin I (p: 0.011), apikal iki boşluk görüntüde daha düşük PW kalınlığı (p:0.020) ve daha düşük tepe sistolik gerilim oranı vardı (p:0.031). NYHA III hastalarda NYHA II hastalara göre daha fazla bozulmuş GLS vardı (p:0.035). Sonuç: Çalışmamız, COVID-19 geçiren akciğer sekeli olmayan hastalarda iskemik veya non-iskemik kökenli kardiyak disfonksiyonun kalıcı dispne ile ilişkili olabileceğini düşündürmektedir.

Anahtar Kelimeler: Dispne; postakut COVID-19 sendromu; kardiyak fonksiyon testleri
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