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Electrocardiographic and echocardiographic findings in long COVID-19: analyzing repolarization alterations and cardiac abnormalities

Authors: Tserendavaa S.1, Munkhsuren Ch.1, Dagdan B.2, Badrakh B.1, Khorloo Ch.1

Company: 1 Departament of Cardiology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
2 Cardiac Rhythmology Center, Third State Central Hospital, Ulaanbaatar, Mongolia

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18S-S105-S111

For citation: Tserendavaa S., Munkhsuren Ch., Dagdan B., Badrakh B., Khorloo Ch. Electrocardiographic and echocardiographic findings in long COVID-19: analyzing repolarization alterations and cardiac abnormalities. Creative Cardiology. 2024; 18 (Special Issue): S105–S111. DOI: 10.24022/1997-3187-2024-18S-S105-S111

Received / Accepted:  07.10.2024 / 23.10.2024

Keywords: repolarization changes TpTe interval QTc interval reactive pericarditis

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Abstract

Purpose. This study aims to identify and compare ECG and echocardiographic abnormalities in long COVID-19 patients, highlighting potential cardiac indicators.

Material and methods. A hospital-based cross-sectional study with case-control analysis was conducted, we will add a detailed explanation of how patients were categorized into case (n = 60) and control groups (n = 60), based on specific criteria such as previously COVID-19 test, symptoms, ECG and echocardiographics with long COVID-19 related changes. Cardiac repolarization parameters, including TpTe interval and QTc interval, were evaluated through electrocardiography (ECG) (Nihon Kohden, 2016). Additionally, echocardiography (Xario 200, Canon, 2018) was employed to assess reactive pericarditis, cardiac contractility, and relaxation. Laboratory data were collected, and statistical analysis was performed using SPSS 26.0 software.

Results. The study cohort had an average age of 45.7 ± 13.4 years. Among the findings, 35.7% of patients exhibited increased pericardial echogenicity, 23% had suspected reactive pericarditis, while 35.7% showed no elevated pericardial echogenicity. The Tp/Te interval, indicative of cardiac repolarization, was significantly prolonged in the case group (0.139 ± 0.02 sec) compared to the control group (0.089 ± 0.01 sec) (p < 0.001). Similarly, the QTc interval was extended by 0.559 ± 0.08 sec in the case group (QTc interval prolongation > 0.480 sec), demonstrating a significant difference from the control group (0.421 ± 0.03 sec) (p < 0.001). The linear regression analysis revealed significant associations between repolarization changes and several predictors in long COVID-19 patients. Notably, elevated triglycerides (β = 0.17, p < 0.001), cholesterol levels (β = 0.11, p < 0.001), TpTe (β = 2.09, p < 0.001), and reactive pericarditis (β = 0.05, p < 0.05) were identified as significant predictors of long COVID-19.

Conclusion. Reactive pericarditis and repolarization changes, including TpTe and pericardial layer parameters, may manifest during the course of long COVID-19.

References

  1. Hastie C.E., Lowe D.J., McAuley A., Mills N.L., Winter A.J., Black C. et al. Natural history of long-COVID in a nationwide, population cohort study. Nat. Commun. 2023; 14 (1): 3504. DOI:/10.1038/s41467-023-39193-y
  2. Klein J., Wood J., Jaycox J.R., Dhodapkar R.M., Lu P., Gehlhausen J.R. et al. Distinguishing features of long COVID identified through immune profiling. Nature. 2023; 623 (7985): 139–148. DOI: 10.1038/s41586-023-06651-y
  3. Giustino G., Croft L.B., Stefanini G.G., Bragato R., Silbiger J.J., Vicenzi M. et al. Characterization of Myocardial Injury in Patients With COVID-19. J. Am. Coll. Cardiol. 2020; 76 (18): 2043–2055. DOI: 10.1016/j.jacc.2020.08.069
  4. Thakore A., Nguyen J., Pollack S., Muehlbauer S., Chi B., Knight D. et al. Electrocardiographic manifestations of COVID-19: Effect on cardiac activation and repolarization. E. Clinical. Medicine. 2021; 39: 101057. DOI: 10.1016/j.eclinm.2021.101057
  5. Tondas A.E., Munawar D.A., Marcantoni I., Liberty I.A., Mulawarman R., Hadi M. et al. Is T-wave alternans a repolarization abnormality marker in COVID-19? An investigation on the potentialities of portable electrocardiogram device. Cardiol. Res. 2023; 14 (1): 45–53. DOI: 10.14740/cr1458
  6. Raman B.,Bluemke D.A., Lüscher T.F., Neubauer S. Long COVID: Post-Acute sequelae of COVID-19 with a cardiovascular focus. Eur. Heart J. 2022; 43 (11): 1157–1172. DOI: 10.1093/eurheartj/ehac031
  7. Gyöngyösi M., Alcaide P., Asselbergs F.W., Brundel B.J.J.M., Camici G.G., Martins P.D.C. et al. Long COVID and the cardiovascular system– elucidating causes and cellular mechanisms in order to develop targeted diagnostic and therapeutic strategies. Cardiovasc. Res. 2023; 119 (2): 336–356. DOI: 10.1093/cvr/cvac115
  8. Aranyó J., Bazan V., Lladós G., Dominguez M.J., Bisbal F., Massanella M. et al. Inappropriate sinus tachycardia in post-COVID-19 syndrome. Sci. Rep., 2022; 12 (1): 298. DOI: 10.1038/s41598-021-03831-6
  9. Dani M., Dirksen A., Taraborrelli P., Torocastro M., Panagopoulos D., Sutton R. et al. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. J. Clin. Med. 2021; 21 (1): e63–e67. DOI: 10.7861/clinmed.2020-0896
  10. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New Eng. J. Med. 2020; 382 (18): 1708–1720. DOI: 10.1056/NEJMoa2002032
  11. Newman M. Chronic fatigue syndrome and long covid: Moving beyond the controversy. BMJ. 2021; 373: 1559. DOI: 10.1136/bmj.n1559
  12. Dennis A., Wamil M., Alberts J., Oben J., Cuthbertson D.J., Wootton D. et al. Multiorgan impairment in low-risk individuals with post- COVID-19 syndrome: A prospective, community-based study. BMJ Open. 2021; 11: e048391. DOI: 10.1136/bmjopen-2020-048391
  13. Sonnweber T., Sahanic S., Pizzini A., Luger A., Schwabl C., Sonnweber B. et al. Cardiopulmonary recovery after COVID-19: An observational prospective multicentre trial. Eur. Respir. J. 2021; 57 (4): 2003481. DOI: 10.1183/13993003.03481-2020
  14. Desai A.D., Boursiquot B.C., Melki L., Wan E.Y. Management of Arrhythmias Associated with COVID-19. Curr. Cardiol. Rep. 2021; 23: 2. DOI: /10.1007/s11886-020-01434-7
  15. Dini F.L., Baldini U., Bytyçi I., Pugliese N.R., Bajraktari G., Henein M.Y. Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome. Int. J. Cardiol. 2023; 374: 129–134. DOI: 10.1016/j.ijcard.2022.12.019
  16. Pornwattanakavee S.P., Priksri W., Leelakanok N. QTc prolongation in patients with COVID-19: A retrospective chart review. Transl. Clin. Pharmacol. 2021; 29 (4): 197–205. DOI: 10.12793/tcp.2021.29.e20
  17. Assiri A.M., Alamaa T., Elenezi F., Alsagheir A., Alzubaidi L., TIeyjeh I. et al. Unveiling the clinical spectrum of post-COVID-19 Conditions: assessment and recommended strategies. Cureus. 2024; 23: 16 (1): e52827. DOI: 10.7759/cureus.52827

About Authors

  • Sumiya Tserendavaa, MD, PhD. Lectuter, Cardiologist; ORCID
  • Chuluunchimeg Munkhsuren, MD, PhD, Cardiologist; ORCID
  • Batnaran Dagdan, MD, Cardiologist; ORCID
  • Burmaa Badrakh, MD, PhD, Assocciate Professor, Lectuter, Cardiologist; ORCID
  • Chingerel Khorloo, MD, PhD, Assocciate Professor, Lectuter, Cardiologist; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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