Left ventricular (LV) involvement
LV systolic and diastolic dysfunction have also been reported in
COVID-19 patients, especially in those with elevated troponin
levels[28,29]. Interestingly, despite conventional ECHO studies
demonstrating only mild LV systolic and diastolic dysfunction, a recent
myocardial deformation analysis study revealed patients who had a normal
LV ejection fraction (LVEF) measured by conventional ECHO had abnormal
LV deformation. This was in the form of abnormal regional longitudinal
deformation (rLS), regional radial strain (rRS) and regional
circumferential strain (rCS) affecting predominantly the basal segments.
Such a pattern is suggestive of a reverse basal takotsubo-like syndrome
in patients with COVID-19, similar to what is seen in Fabry’s or
Friedrich’s disease[30–32]. Myocardial involvement in the basal/mid
infero-/anterolateral LV segments was thought to be partly a result of
hydrostatic edema due to the supine position of the patient. Such
reverse basal takotsubo-like syndrome picture could also be explained by
the edema leading to abnormal basal rRS curves without significant
alterations during systole[30]. Furthermore, COVID myocarditis
exhibits a transmural myocardial involvement as evidenced by the
severely impaired CS, as it is triggered by cytokine storm. This finding
differs from typical viral myocarditis which often affects the
epi-myopericardial segments.[30]. In a multicenter study by Giustino
et al., patients with myocardial injury as defined by elevated cardiac
biomarkers, had more wall motion abnormalities (WMAs) in apical and mid
segments, while basal WMAs were numerically higher in patients with no
myocardial injury. Furthermore, WMAs were more frequently observed in
patients with regional ST-segment deviations[33].