Left-ventricular diastolic dysfunction in coronavirus disease: opening Pandora’s box!

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Korean J Anesthesiol. 2021;74(6):557-558
Publication date (electronic) : 2021 January 13
doi : https://doi.org/10.4097/kja.21010
Department of Cardiac Anesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
Corresponding author: Rohan Magoon, D.M., M.D. Department of Cardiac Anesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi 110001, India Tel: +91-9711128628 Email: rohanmagoon21@gmail.com
Received 2021 January 7; Accepted 2021 January 11.

As I read through the articles featured in a recent issue of the Korean Journal of Anesthesiology [1,2] that outlined the perioperative implications of coronavirus disease (COVID-19), I felt motivated to highlight the importance of COVID-19-related left-ventricular (LV) diastolic dysfunction (LVDD) in the management of this predisposed subset, particularly since the cardiovascular consequences of COVID-19 continue to be ardently discussed [3].

A systematic echocardiographic evaluation of 100 COVID-19 patients with a mean age of 66 years by Szekely et al. [4] revealed a 16% incidence rate of LVDD despite a preserved LV systolic function in as high as 90% of their patients. In addition to subclinical ventricular relaxation impairment given the advanced age of the patients and comorbidities such as systemic hypertension, the conglomeration of factors specific to COVID-19, such as systemic inflammatory milieu, endothelial dysfunction, microvascular thrombosis, arrhythmias, disturbed ventricular cross-talk (owing to the concomitant right ventricular dysfunction resulting from pulmonary hypertension), and myocardial oxygen supply-demand perturbations, can contribute significantly to LVDD, with a subsequent accentuated potential to culminate in heart failure with a preserved ejection fraction (HFpEF) [3,4].

Moreover, the use of high positive end-expiratory pressure (PEEP), which is quite commonly employed while ventilating hypoxemic COVID-19 patients, can result in an attenuated cardiac output in addition to the already impaired ventricular filling in HFpEF. This observation is supported by Chin et al. [5], who elaborated on progressive deterioration in LV lusitropy with the application of high PEEP in patients with pre-existing LV relaxation abnormalities. In addition, the underlying cardiopulmonary interactions present unique challenges in weaning mechanically ventilated patients with coexistent LVDD [3,5].

An improved comprehension of the likelihood of an altered diastology in COVID-19 patients is pivotal in staging a more well-directed management approach wherein targeted echocardiographic surveillance, cardiac biomarkers, and combined heart-lung ultrasound and inodilators can assist in the overall management of this critically ill cohort.




Conflicts of Interest

No potential conflict of interest relevant to this article was reported.


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