Study on the evaluation of early subclinical myocardial damage in patients after long COVID syndrome by two⁃dimensional speckle tracking imaging
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摘要:
目的：应用二维斑点追踪技术评价长新冠综合征患者早期亚临床心肌损害的应用价值。方法：在南京医科大学第一附属医院门诊连续入组2022年12月7日我国放开疫情管控后新冠感染患者59例作为观察组，选取新冠流行前门诊者60例作为健康对照组，收集患者基本临床资料及心肌损伤标志物等化验指标，采用二维心超及二维斑点追踪技术（two-dimensional speckle tracking imaging，2D-STI）评估患者左室射血分数（left ventricular ejection fraction，LVEF）、左室舒张功能E/A、E/e’，左心室整体纵向应变（global longitudinal strain，GLS）及十八节段应变值，计算并比较各组间心率、LVEF、E/A、E/e’、GLS及十八节段应变值。结果：研究发现长新冠综合征患者的左室舒张功能E/A（1.14±0.34 vs. 1.46±0.44，P<0.001）、E/e’（8.01±2.08 vs. 7.21± 1.53，P<0.05）及左室GLS［（-20.57±2.15）% vs.（-21.90±1.73）%，P<0.001］较健康对照组显著下降。进一步行十八节段应变分析发现新冠组患者主要表现为前间隔基底部、前壁中间部、前间隔中间部、下侧壁中间部、前侧壁中间部、前壁心尖部、前间隔心尖部、下壁心尖部、下侧壁心尖部和前侧壁心尖部等十个节段的显著降低（P<0.05）。通过感染后时间的亚组分析发现，随着新冠康复时间延长，患者GLS呈现逐渐改善趋势。结论：新冠后患者常出现左室舒张功能及GLS的下降。而随着新冠康复时间的延长，上述指标呈现逐渐改善趋势。应用2D-STI可以定量评估长新冠综合征患者早期亚临床心肌损害，可能为新冠患者的临床诊治提供一定依据。
Abstract:
Objective：To evaluate the application value of early subclinical myocardial damage in patients with long COVID using two-dimensional speckle tracking imaging（2D-STI）technology. Methods：Fifty-nine patients with post-COVID infection after the unsealing of the COVID epidemic in China on December 7，2022 were enrolled as the observation group，and 60 pre-epidemic healthy people who were screened in the out patient department were selected as the healthy control group. Basic clinical data，markers of myocardial injury and other laboratory indicators of patients were collected. Two-dimensional echocardiography and 2D-STI were used to evaluate left ventricular ejection fraction（LVEF），left ventricular diastolic function（E/A，E/e’），global longitudinal strain（GLS）， and segmental strain values，and the heart rate，LVEF，E/A，E/e’，GLS，and segmental strain values were calculated and compared between the groups. Results：The study found that the left ventricular diastolic function E/A（1.14±0.34 vs. 1.46±0.44，P<0.001），E/e’ （8.01±2.08 vs. 7.21±1.53，P<0.05），and GLS［（-20.57±2.15）% vs.（-21.90±1.73）%，P<0.001］of patients with long COVID syndrome were significantly decreased compared to healthy control individuals. Further segmental strain analysis revealed significant decreases in ten segments，including basal anteroseptal，mid anterior，mid anteroseptal，mid inferolateral，mid anterolateral，apical anterior，apical anteroseptal，apical inferior，apical inferolateral and apical anterolateral in the COVID group（P<0.05）. Subgroup analysis based on post-infection time found that as the recovery time from COVID prolonged，the GLS of patients showed a gradual improvement trend. Conclusion：Patients after COVID infection often experience a decrease in left ventricular diastolic function and GLS. With the prolongation of COVID recovery time，the above indicators show a gradual improvement trend. The application of 2D-STI technique can quantitatively evaluate early subclinical myocardial injury in patients with long novel coronavirus syndrome，which may provide evidence for clinical diagnosis and treatment of COVID patients.
