SPC365

Is standard cardiac evaluation enough for COVID-19 patients with severe disease?

Session: Posters (Sessão 6 - Écran 6) - Doença Cardiovascular em Populações Especiais 2 - Covid 19
Speaker: Miguel Azaredo Raposo

Congress: CPC 2022
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.14 Cardiovascular Disease in Special Populations - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Miguel Azaredo Raposo; Joana Brito; Sara Couto Pereira; Beatriz Valente Silva; Pedro Silvério António; Ana Margarida Martins; Catarina Simões de Oliveira; Ana Abrantes; Catarina Gregório; João Santos Fonseca; Ana Beatriz Garcia; Fausto j. Pinto; Ana g. Almeida

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Acute infection by SARS-COV2 has been broadly associated with cardiovascular disease. An increased burden is seen in patients (pts) with severe lung disease and pro-inflammatory status. The cardiac long-term impact of COVID-19 is still unclear.</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate the long-term impact of COVID-19 on patients admitted to the intensive care unit (ICU).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">This was a single-center, observational and prospective study which included (pts) requiring admission to the ICU due to COVID-19 from January to November 2020 who accepted to submit to pos-discharge clinical evaluation. Severe disease was defined as the necessity of invasive mechanical ventilation and either severe ARDS or involvement &gt;75% of lung parenchyma in CT scan. Statistical analysis was performed with Mann-Whitney and Chi-square.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 43 pts (mean age 64&plusmn;12, 67.4% males) were included. During ICU admission 49% presented with severe ARDS, 51% with moderate and a minimum P/F ratio of 100&plusmn;40. The mean troponin levels were 37&plusmn;43 pg/mL. Concerning acute disease complications, segmental pulmonary embolism (PE) was documented in 21% with no detection of central PE, acute kidney injury in 39.5% and shock in 14% pts.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Follow-up evaluation was performed 189&plusmn;83 days after discharge. All pts were in sinus rhythm except for one, who had prior atrial fibrillation diagnosis. With standard echocardiogram, no significant biventricular dysfunction was reported (mean LVEF 58&plusmn;7.8 and mean TAPSE 21&plusmn;4), a median elevation of E/e&rsquo; was reported as 10.3&plusmn;4.8 and diastolic dysfunction was present in 35% pts.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Fatigue was the most frequently reported symptom (52% pts) and no association was found with NT-proBNP elevation, LVEF reduction, diastolic dysfunction, echocardiographic probability of pulmonary hypertension, RV systolic dysfunction or dilation. Likewise, fatigue on follow-up did not correlate with the highest troponin T levels, disease severity or complications during acute disease. Pts that reported fatigue had a significantly lower 6-min walking test performance (526&plusmn;115 vs 432&plusmn;170 p= 0.016).</span></span></span></p>

<p><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">This study suggests that the most frequent sequela for severe COVID-19 survivors is fatigue, confirmed by a 6-min walking test. The lack of correlation between fatigue and standard echocardiographic or NT-proBNP suggests either a non-cardiac mechanism for post-COVID-19 fatigue or a lack of sensitivity for these parameters in diagnosing post-COVID-19 cardiac disease.</span></span></span></p>