Injuria cardiaca post covid-19 y su relación con la severidad del cuadro agudo, los síntomas persistentes y la vacunación

Background: COVID-19 is associated with cardiovascular involvement in the acute phase. The information about cardiacinvolvement after COVID-19 is heterogeneous, and the indication to routinely perform cardiac imaging tests is still controversial.There is no updated information on the effect mass vaccination has on the incidence of cardiac injury after COVID-19.Objectives: The primary objective of this study was to evaluate the prevalence of cardiac injury after COVID-19 by transthoracicechocardiography and its association with the severity of the acute phase and with persistent symptoms after recovery. Thesecondary objective was to explore the association of the prevalence of cardiac injury with the beginning of the vaccinationcampaign against COVID-19 in Argentina. Methods: We conducted an observational, single-center, and retrospective study. All the consecutive patients who consultedfor post-COVID-19 evaluation were included. All the patients underwent transthoracic echocardiography. The date thevaccination campaign started (12/29/2020) was considered the cut-off point for the analysis of the pre-vaccination and postvaccination subgroups.Results: The first 1000 patients who consulted in our center between 09/01/2020 and 09/01/2021 were included. Thirty-ninepatients (3.9%) had new abnormal echocardiographic findings suggestive of cardiac injury after COVID-19, including leftventricular dysfunction (2.8%), pericardial effusion (0.5%), and wall motion abnormalities (0.6%). Patients with moderateor severe acute COVID-19 presented a higher prevalence of wall motion abnormalities (2.9% versus 0.3%, p= 0.001) andpericardial effusion (2.9% versus 0.14%, p = 0.001) compared to those with asymptomatic or mild COVID-19 and this associationremained after adjusting for cardiovascular risk factors and age (OR 6.7, 95% CI 1.05-4.2, p = 0.04, and OR 25.1, 95%2.1-304.9, p = 0.01 respectively). The percentage of patients who reported persistent symptoms during consultation afterCOVID-19 was 19.3%, and they had higher evidence of new left ventricular dysfunction (8.3% vs. 2.4%, p < 0.005); however,this association lost significance on multivariate analysis. When the association of cardiac injury with the start of vaccinationwas considered, the 330 patients who underwent post-COVID assessment before the vaccination campaign started hada higher prevalence of injury than the 670 patients evaluated after this date (6.3% vs. 2.7%, p = 0.006). and this associationpersisted on multivariate analysis (OR 0.35; 95%CI 0.17-0.69).Conclusion: The prevalence of cardiac injury assessed by echocardiography after COVID-19 was 3.9%. There was a significantand independent association between the severe initial presentations and the abnormal echocardiographic findings afterCOVID-19, but not with persistent symptoms. Patients who consulted after the vaccination campaign started in Argentinahad a lower prevalence of cardiac injury compared with those patients in the first wave.