Echocardiographic characteristics of patients with SARS-CoV-2 infection

Clin Res Cardiol. 2020 Dec;109(12):1549-1566. doi: 10.1007/s00392-020-01727-5. Epub 2020 Aug 14.


Background: Myocardial involvement induced by SARS-CoV-2 infection might be important for long-term prognosis. The aim of this observational study was to characterize the myocardial effects during SARS-CoV-2 infections by echocardiography.

Results and methods: An extended echocardiographic image acquisition protocol was performed in 18 patients with SARS-CoV-2 infection assessing LV longitudinal, radial, and circumferential deformation including rotation, twist, and untwisting. Furthermore, LV deformation was analyzed in an age-matched control group of healthy individuals (n = 20). The most prevalent finding was a reduced longitudinal strain observed predominantly in more than one basal LV segment (n = 10/14 patients, 71%). This pattern reminded of a "reverse tako-tsubo" morphology that is not typical for other viral myocarditis. Additional findings included a biphasic pattern with maximum post-systolic or negative regional radial strain predominantly basal (n = 5/14 patients, 36%); the absence or dispersion of basal LV rotation (n = 6/14 patients, 43%); a reduced or positive regional circumferential strain in more than one segment (n = 7/14 patients, 50%); a net rotation showing late post-systolic twist or biphasic pattern (n = 8/14 patients, 57%); a net rotation showing polyphasic pattern and/or higher maximum net values during diastole (n = 8/14 patients, 57%).

Conclusion: Myocardial involvement due to SARS-CoV-2-infection was highly prevalent in the present cohort-even in patients with mild symptoms. It appears to be characterized by specific speckle tracking deformation abnormalities in the basal LV segments. These data set the stage to prospectively test whether these parameters are helpful for risk stratification and for the long-term follow-up of these patients.

Keywords: COVID-19; Deformation imaging; Myocardial strain; Myocarditis; Rotation; SARS-CoV-2.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / virology
  • Case-Control Studies
  • Echocardiography*
  • Female
  • Heart / diagnostic imaging*
  • Heart / physiopathology
  • Heart / virology
  • Host-Pathogen Interactions
  • Humans
  • Male
  • Middle Aged
  • Myocarditis / diagnostic imaging*
  • Myocarditis / physiopathology
  • Myocarditis / virology
  • Predictive Value of Tests
  • SARS-CoV-2 / pathogenicity
  • Severity of Illness Index
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Dysfunction, Left / virology
  • Ventricular Function, Left