Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID‐19 without overt myocarditis: A pilot study

Abstract

Abstract Usual clinical testing rarely reveals cardiac abnormalities persisting after hospitalization for COVID. Such testing may overlook residual changes causing increased adverse cardiac events post‐discharge. To clarify status post‐hospitalization, we related exercise stress echocardiography (ESE) in 15 recovering patients (RP) age 30–63 without myocarditis to matching published data from healthy subjects (HS). RP exercise, average duration 8.2 ± 2.2 SD, was halted by dyspnea or fatigue. RP baselines matched HS except for higher heart rate. At peak stress, RP had significantly lower mean left ventricular (LV) ejection fraction (67% ± 7 vs. 73% ± 5, p < 0.0017) and higher peak early mitral inflow velocity/early mitral annular velocity (E/e’, 9.1 ± 2.5 vs. 6.6 ± 2.5, p < 0.006) compared with HS performing equal exercise (8.5 ± 2.6 min). Thus, when stressed, patients without known cardiac impairment showed diminished systolic contractile function and diastolic LV compliance vs. HS. RP peak heart rate was significantly higher (172 ± 18 vs. 153 ± 20); peak systolic blood pressure trended higher (192 ± 31 vs. 178 ± 19). Pulmonary artery systolic pressures among RP remained normal. ESE uniquely identified residual abnormality in cardiac contractile function not evident unstressed, exposing previously unrecognized residual influence of COVID‐19. This may reflect autonomic dysfunction, microvascular disease, or diffuse interstitial changes; these results may have implications for clinical management and later prognosis.

Keywords

• COVID‐19
• left ventricular dysfunction
• stress echocardiography