Pelin KARACA ÖZER, Elif AYDUK GOVDELI, Mustafa ALTINKAYNAK, Derya BAYKIZ, Huzeyfe ARICI, Yunus ÇATMA, Alpay MEDETALİBEYOĞLU, Ekrem Bilal KARAAYVAZ

COVID-19'dan iyileşme sonrası tedavi rejimlerine göre biventriküler miyokard geriliminin karşılaştırılması

Amaç: COVID-19' da farklı terapötik stratejiler uygulanmıştır ve bu stratejilerin kardiyak fonksiyon üzerindeki etkisi belirsizdir. Çalışmanın amacı, COVID-19' dan iyileşen hastalarda farklı tıbbi tedavilerin biventriküler fonksiyon üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntem: COVID-19'dan iyileştikten sonra takip ziyaretlerinde hastaların biventriküler miyokardiyal işlevini incelemek için benek izleme ekokardiyografisi yapıldı. Hastaların aktif hastalık sırasında kullandığı medikasyonlar retrospektif olarak öğrenildi ve favipiravir (FAV, n=60) ve hidroksiklorokin (HCQ, n=60) alanlar olmak üzere iki gruba ayrıldı. Risk faktörü uyumlu kontroller (n=41) ile bir karşılaştırma yapıldı. Bulgular: Toplam 161 hasta çalışmaya dahil edildi. Sol ventrikül diyastol sonu hacmi, sistol sonu hacmi, diyastol sonu çapı ve sistol sonu çapı HCQ ve FAV gruplarında kontrollere göre daha yüksekti, ancak gruplar arasında sol ventrikül ejeksiyon fraksiyonu benzerdi. Kontrollere göre HCQ ve FAV gruplarında sağ ventrikül çapı artmış ve sistolik pulmoner arter basıncı daha yüksekti. HCQ grubunda, FAV ve kontrol grupları ile karşılaştırıldığında, sol ventrikül global uzunlamasına gerilim (%-18±6,6; %-19,7±4,4; %-20,4±5; sırasıyla), sağ ventrikül global uzunlamasına gerilim (%-19,8±7,5; %-22,2±6; %-23,4±6,2; sırasıyla) ve sağ ventrikül serbest duvar gerilimi (%-16,9±3,6; %-18,2±2,4; %-19,6±4,7; sırasıyla) daha kötüydü. Sonuç: Çalışmamızdaki mevcut sonuçlara dayanarak, hem HCQ hem de FAV gruplarında kontrollere kıyasla subklinik kardiyak etkilenmenin ekokardiyografik kanıtları vardır. Bununla birlikte, HCQ tedavisi, FAV ile karşılaştırıldığında COVID-19'dan kurtulanlarda biventriküler subklinik sistolik disfonksiyon riskinde artış ile ilişkilendirilmiştir.

Anahtar Kelimeler:

COVID-19, iyileşme, favipiravir, hidroksiklorokin, benek izleme ekokardiyografi.

Comparison of biventricular myocardial strain according to treatment regimens in patients discharged after COVID-19 recovery

Purpose: The effects of different COVID-19 therapeutic strategies on cardiac function are uncertain. Therefore, this study aimed to evaluate the effects of different medical treatments on biventricular function in patients who had recovered from COVID-19. Materials and Methods: Speckle-tracking echocardiography was performed to examine the biventricular myocardial function of patients at follow-up visits after recovery from COVID-19. The patients were divided into two groups based on the medication they used during the active disease: favipiravir (FAV; n = 60) or hydroxychloroquine (HCQ; n = 60). A comparison was made with risk factor–matched controls (n = 41). Results: A total of 161 patients were included in the study. The left ventricular end-diastolic volume, end-systolic volume, end-diastolic diameter, and end-systolic diameter were higher in the HCQ and FAV groups compared to the controls, while the left ventricular ejection fraction was similar between all the groups. The right ventricular diameter was increased, and the systolic pulmonary artery pressure was higher in the HCQ and FAV groups compared to the controls. The left ventricular global longitudinal strain (-18±6.6 vs. -19.7±4.4 vs. -20.4±5, respectively), the right ventricular global longitudinal strain (-19.8±7.5 vs. -22.2±6 vs. -23.4±6.2, respectively), and the right ventricular free wall strain (-16.9±3.6 vs. -18.2±2.4 vs. -19.6±4.7, respectively) were worse in the HCQ group compared to the FAV and control groups. Conclusion: This study found echocardiographic evidence of subclinical cardiac involvement in both the HCQ and FAV groups compared to the controls. However, HCQ treatment was associated with an increased risk of biventricular subclinical systolic dysfunction in COVID-19 survivors compared with FAV treatment.

Keywords:

COVID-19, recovery, favipiravir, hydroxychloroquine, speckle tracking echocardiography,

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