Cardiac structure and function 1.5 years after COVID-19: results from the EPILOC study, 2025, Schellenberg et al.

[SNT Gatchaman]

Cardiac structure and function 1.5 years after COVID-19: results from the EPILOC study
Schellenberg, Jana; Matits, Lynn; Bizjak, Daniel A.; Deibert, Peter; Friedmann-Bette, Birgit; Göpel, Siri; Merle, Uta; Niess, Andreas; Frey, Norbert; Morath, Oliver; Erz, Gunnar; Peter, Raphael S.; Nieters, Alexandra; Rothenbacher, Dietrich; Kern, Winfried V.; Steinacker, Jürgen M.

PURPOSE
Impaired left and right ventricular (LV/RV) function during acute SARS-CoV-2 infection has been predominantly reported in hospitalized patients, but long-term cardiac sequelae in large, well-characterized cohorts remain inconclusive. This study evaluated cardiac structure and function in individuals with post-Coronavirus disease (COVID) syndrome (PCS) compared to recovered controls (CON), focusing on associations with cardiopulmonary symptoms and rapid physical exhaustion (RPE).

METHODS
This multicenter, population-based study included 1154 participants (679 PCS, 475 age-and sex matched CON; mean age 49 ± 12 years; 760 women) 1.5 years post-infection. Transthoracic echocardiography assessed LV global longitudinal strain (GLS), RV GLS and RV free wall strain (FWS), and other measures. Cardiopulmonary exercise testing (CPET) measured maximum respiratory oxygen uptake (VO2max) as a marker of cardiopulmonary fitness.

RESULTS
PCS participants exhibited significantly lower LV GLS (-20.25% [-21.28 – -19.22] vs. -20.73% [-21.74 – -19.72], p = 0.003), reduced diastolic function (E/A 1.16 [1.04–1.27] vs. 1.21 [1.1–1.32], p = 0.022) and decreased TAPSE (24.45 mm [22.14–26.77] vs. 25.05 mm [22.78–27.32], p = 0.022) compared to CON, even after adjusting for confounders. RV strain values were similar between groups. LV GLS correlated inversely with VO2max (p = 0.004) and positively with RPE (p = 0.050), though no associations were observed with other cardiopulmonary symptoms.

CONCLUSIONS
This study demonstrates subtle yet consistent reductions in LV function, specifically LV GLS and diastolic function, and exercise capacity in PCS compared to CON. While these changes are within reference ranges, their potential impact on clinical outcomes warrants further investigation. These findings highlight the need for cardiac assessments and long-term follow-up in symptomatic PCS patients.

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[Utsikt]

During the acute infection, PCS were more frequently hospitalized (8.2% vs. 1.3%, p < 0.001) and medically treated (47% vs. 9.3%, p < 0.001).

It’s mostly milder infections.

This study demonstrates subtle yet consistent reductions in LV function, specifically LV GLS and diastolic function, and exercise capacity in PCS compared to CON.

This is inaccurate. It shows lower values, but there’s no way of knowing if it’s a reduction due to Covid or effects of LC. It might as well be that those with lower values originally had a higher chance of getting LC.

They sort of acknowledge this in the strengths and limitations section:

However, the lack of pre-COVID-19 echocardiographic data limits the ability to directly assess changes from pre-infection to the evaluation period.

Future studies should incorporate pre-infection data, specifically investigate variant-specific impact on cardiac function, and apply advanced statistical methodologies to address confounding variables more effectively.