J Korean Med Sci.  2020 Oct;35(40):e366. 10.3346/jkms.2020.35.e366.

Cardiac Manifestations of Coronavirus Disease 2019 (COVID-19): a Multicenter Cohort Study

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
  • 3Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
  • 4Data Science Team (Biostatistician), Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 5Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 6Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
  • 7Chungju Medical Center, Chungju, Korea

Abstract

Background
This study aimed to investigate the cardiac manifestations of coronavirus disease 2019 (COVID-19).
Methods
From February to March 2020, we prospectively and retrospectively enrolled consecutive patients diagnosed with COVID-19. Patient's data such as the demographic characteristics, symptoms, vital signs, laboratory and radiologic findings, electrocardiographic, and echocardiographic data, including the global longitudinal strain (GLS) of both ventricles, were obtained.
Results
Forty patients (median age, 58 years; 50% men) were enrolled in the initial analysis. Patients were classified into severe and nonsevere groups based on the current guidelines. The 13 patients in the severe group were significantly older, had a greater prevalence of bilateral pneumonia and leukocytosis, and higher aspartate transaminase levels than patients in the nonsevere group. Patients in the severe group had a slightly lower left ventricular ejection fraction (LVEF) than those in the nonsevere group (median [interquartile range], 61.0% [58.5%, 62.3%] vs. 66.7% [60.6%, 69.8%], P = 0.015). In a subgroup of 34 patients in whom GLS could be analyzed, patients in the severe group had a significantly impaired left ventricular GLS (LVGLS) than those in the nonsevere group (−18.1% [−18.8%, −17.1%] vs. −21.7% [−22.9%, −19.9%], P = 0.001). There were no significant differences in total wall (RVGLS total , −19.3% [−23.9%, −18.4%] vs. −24.3% [−26.0%, −22.6%], P = 0.060) and free wall (RVGLS fw , −22.7% [−27.2%, −18.6%] vs. −28.8% [−30.4%, −24.1%], P = 0.066) right ventricle GLS (RVGLS).
Conclusion
Patients with severe COVID-19 had lower LVEF and LVGLS. RVGLS was not different between patients with severe and nonsevere COVID-19.

Keyword

Coronavirus; COVID-19; Echocardiography; Global Longitudinal Strain; Ejection Fraction; Disease Severity
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