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WASE II: Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-Up of The World Alliance Societies of Echocardiography (WASE-COVID) Study.

  • | By Ultromics

Karagodin et al, J Am Soc Echocardiogr. 2021.

COVID-19 infection is known to cause a wide array of clinical chronic sequelae but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the cardiac remodelling that occurs following acute infection. 

Patients enrolled in the WASE-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram (TTE). Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyzable, including left ventricular (LV) volumes, ejection fraction (EF), and longitudinal strain (LVLS). Right-sided echocardiographic parameters included right ventricular (RV) global longitudinal strain (RVGLS), RV free wall strain (RVFWS), and RV basal diameter (RVBD). Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function.

For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not significantly different from baseline (all p>0.5). Patients with hyperdynamic LVEF at baseline (>70%), had a significant reduction of LVEF at follow-up (74.3±3.1% vs. 64.4±8.1 %, p<0.001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5±5.9% vs 49.3±13.4% , p=0.02), and those with normal LVEF had no change.

Patients with normal LVLS (<-18%) at baseline, had a significant reduction of LVLS at follow-up (-21.6±2.6 % vs. -20.3±4.0% , p=0.006), while patients with impaired LVLS at baseline, had a significant improvement at follow-up (-14.5±2.9 % vs. -16.7±5.2%, p<0.001).

Patients with abnormal RVGLS (>-20%) at baseline, had significant improvement at follow-up (15.2±3.4 % vs. -17.4±4.9 %, p=0.004). Patients with abnormal RVBD (>4.5 cm) at baseline, had significant improvement at follow-up (4.9±0.7 cm vs 4.6±0.6 cm, p=0.019).


Overall, there were no significant changes overtime in LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. LV and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV. 

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