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Myocardial strain assessed with speckle tracking echocardiography is a sensitive marker of cardiac dysfunction. Both left-ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were affected by severe SARS-CoV-2 infection. However, data about cardiac involvement in patients with asymptomatic/mild Coronavirus disease-19 (COVID-19) is still lacking.To evaluate myocardial function using LV-GLS and RV-LS in patients with previous asymptomatic/mild COVID-19.Forty young adults without previously known comorbidities/cardiovascular risk factors and with a confirmed diagnosis of asymptomatic or paucisymptomatic SARS-CoV-2 infection were retrospectively included. A 2D-transthoracic echocardiogram with speckle tracking analysis was performed at least 3 months after the diagnosis. Forty healthy subjects, matched for age, sex, and body surface area in a 1:1 ratio were used as the control group.Left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and RV-LS were comparable between the two groups. LV-GLS was significantly lower in the cases compared to the control group (-22.7 ± 1.6% vs. -25.7 ± 2.3%; p.001). Moreover, the prevalence of regional peak systolic strain below -16% in at least two segments was three times higher in patients with previous COVID-19 compared to controls (30% vs. 10%, p = .02). In multivariable logistic regression, previous COVID-19 infection was independently associated with reduced LV-GLS values (p.001).SARS-CoV-2 infection may affect left ventricular deformation in 30% of young adult patients despite an asymptomatic or only mildly symptomatic acute illness. Speckle-tracking echocardiography could help early identification of patients with subclinical cardiac involvement, with potential repercussions on risk stratification and management.

SYNOPSIS Coronavirus disease 2019 (COVID-19) could have a direct or indirect effect on the cardiovascular system. To detect cardiac involvement, trans-thoracic echocardiography (TTE), as a widely available and cost-effective tool, is highly recommended and can provide important information that can affect the clinical management of COVID-19 patients. Despite that, considering the risk of equipment contamination and personnel exposure, mainly focused echocardiographic evaluations instead of complete examination are recommended and the use of portable devices easy to disinfect with offline reporting is highly suggested. Accordingly, cardiac imaging examination should be considered only when it could change the clinical management or be lifesaving for the patients. COVID-19, through different mechanisms, could affect different sections of the heart and it is useful to analyze them separately during an echocardiographic examination. Regarding the left ventricle, the SARS-CoV-2 infection could lead to acute myocardial infarction, tako-tsubo syndrome and in particular acute myocarditis. The impairment of the pulmonary circulation and the higher prevalence of pulmonary embolism in these patients explain and correlate with some pathological findings as right ventricular systolic dysfunction and direct or indirect signs of pulmonary hypertension, which could easily be assessed by echocardiography and with notable prognostic meaning. Some reports also described acute pericarditis and cardiac effusion during SARS-COV-2 infection and echocardiography is the first recommended diagnostic tool to evaluate the pericardial involvement, especially to exclude signs of cardiac tamponade that rapidly deteriorate the clinical state of the patients. However, available echocardiographic data on COVID-19 patients are scarce and actually does not provide definite evidence and more studies are certainly needed to better evaluate this topic.

Background Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial...