Mitral Annular Plane Systolic Excursion: An Early Marker of Subclinical Left Ventricular Function in COVID-19 Survivors
Excursión sistólica del plano anular mitral: un marcador temprano de la función subclínica del ventrículo izquierdo en sobrevivientes de COVID-19
Uğur Küçük, Pınar Mutlu, Arzu Mirici, Uğur Özpınar
Abstract
Introduction: The left ventricular (LV) function can be affected by COVID-19. Mitral annular plane systolic excursion (MAPSE) is a measurement that reflects the function of the LV. The association between MAPSE and LV function in COVID-19 survivors is not well understood, and this study aimed to explore that relationship.
Material and methods: The retrospective cross-sectional study comprised 99 patients with a history of SARS-CoV-2 infection. These patients experienced symptoms lasting more than 2 months following the initial SARS-CoV-2 virus infection, including fatigue, shortness of breath, chest pain, and cough. The patients were categorized into two groups based on their MAPSE measurements: those with low MAPSE (<12 mm) and those with non-low MAPSE (>12 mm). MAPSE measurements were acquired using transthoracic echocardiography (TTE).
Results: COVID-19 patients with low MAPSE, global longitudinal strain (GLS) (%) ([-17.61±0.95] - [-18.90±1.08], p <0.001) and mitral E/A ratio ([0.83±0.39] - [0.97±0.23], p = 0.028) were statistically significant compared to the the group without low MAPSE. Left atrial volume index (LAVI) in mm/m2 ([37.24±2.11] - [35.34±2.50], p =0.001) was higher in the group of COVID-19 patients with lower MAPSE. High-sensitivity troponin T (Hs-TnT) (OR: 2.019, 95% CI: 1.043-3.712, p =0.028), intensive care unit (ICU) admission (OR: 1.432, 95% CI: 1.004-2.708, p =0 .037) and need for invasive mechanical ventilation (IMV) support (OR: 1.306, 95% CI: 1.128-2.630, p =0.004) were identified as independent predictors of reduced MAPSE.
Conclusions: SARS-CoV-2 infection may lead to reduced or impaired MAPSE values, indicative of impaired LV function, in COVID-19 survivors. Additionally, our study revealed that elevated levels of (Hs-TnT), admission to the ICU, and the need for IMV support were predictive factors for low MAPSE values. These findings underscore the potential cardiac implications of COVID-19 and highlight the importance of monitoring cardiac function in patients with severe disease manifestations.
Keywords
Resumen
Introducción: La función del ventrículo izquierdo (VI) puede verse afectada por el COVID-19. La excursión sistólica del plano anular mitral (MAPSE) es una medición que refleja la función del VI. La asociación entre MAPSE y la función del VI en los sobrevivientes de COVID-19 no se comprende bien y este estudio tuvo como objetivo explorar esa relación.
Material y métodos: Estudio transversal retrospectivo que incluyó a 99 pacientes con antecedentes de infección por SARS-CoV-2. Estos pacientes experimentaron síntomas que duraron más de dos meses después de la infección inicial por el virus SARS-CoV-2, incluyendo fatiga, dificultad para respirar, dolor en el pecho y tos. Los pacientes se clasificaron en dos grupos según sus mediciones de MAPSE: aquellos con MAPSE bajo (<12 mm) y aquellos con MAPSE no bajo (>12 mm). Las mediciones MAPSE se adquirieron mediante ecocardiografía transtorácica (ETT).
Resultados: Pacientes con COVID-19 con MAPSE bajo, tensión longitudinal global (GLS) (%) ([-17,61±0,95] - [-18,90±1,08], p<0,001) y relación E/A mitral ([0,83±0,39] - [0,97±0,23], p = 0,028) fueron estadísticamente significativos en comparación con el grupo sin MAPSE bajo. El índice de volumen auricular izquierdo (LAVI) en mm/m2 ([37,24±2,11] - [35,34±2,50], p =0,001) fue mayor en el grupo de pacientes con COVID-19 con MAPSE más bajo. Troponina T de alta sensibilidad (TnT-Hs) (OR: 2,019, IC 95%: 1,043-3,712, p = 0,028), ingreso a unidad de cuidados intensivos (UCI) (OR: 1,432, IC 95%: 1,004-2,708, p = 0,037) y la necesidad de soporte de ventilación mecánica invasiva (VMI) (OR: 1,306, IC 95%: 1,128-2,630, p = 0,004) se identificaron como predictores independientes de MAPSE reducido.
Conclusiones: La infección por SARS-CoV-2 puede provocar valores reducidos o alterados de MAPSE, indicativos de una función del VI alterada, en los supervivientes de COVID-19. Además, nuestro estudio reveló que los niveles elevados de (TnT-Hs), el ingreso en UCI y la necesidad de soporte de VMI eran factores predictivos de valores bajos de MAPSE. Estos hallazgos subrayan las posibles implicaciones cardíacas de la COVID-19 y resaltan la importancia de controlar la función cardíaca en pacientes con manifestaciones graves de la enfermedad.
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References
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Submitted date:
02/20/2024
Reviewed date:
03/14/2024
Accepted date:
03/26/2024
Publication date:
03/26/2024
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