The features of the heart chamber remodeling process in patients with ST-segment elevation myocardial infarction and SARS-CoV-2 infection

To evaluate the prognostic value of cardiac chamber remodeling in patients with ST-segment elevation myocardial infarction and SARS-CoV-2 infection (COVID-19). 
Materials and methods. A prospective cohort study included 60 participants, matched for age, gender, and the Charlson Comorbidity Index. The participants were divided into three groups of 20: the study group, which included patients with STEMI and COVID-19; a comparison group of patients with STEMI but without COVID-19; and a third comparison group consisting of patients with COVID-19 but without STEMI. The analysis of instrumental data and long-term follow-up of patients after hospital discharge were conducted. 
Results. In patients with STEMI and COVID-19, various types of LV myocardial remodeling were most often observed. The patients with COVID-19 without STEMI showed the highest LV ejection fraction (LVEF): 60.0 (55.5–60.0%), whereas STEMI with COVID-19 groups had LVEF as 54.5 (47.5– 58.0), and STEMI without COVID-19 had LVEF: 49.5 (46.0–55.5), p = 0.005. The median of LVMi g/m2 in STEMI and COVID-19 group was 117.8 (106.1–132.5); in COVID-19 group without STEMI — 110.1 (89.4–130.9); lower LVMi were detected in the group with STEMI without COVID-19 - 92.4 (85.5–111.3), p = 0.027. Signs of pulmonary hypertension (PH) were significantly more frequently found in patients with COVID-19: 7 patients of STEMI + COVID-19 group, and in 9 subjects of the non-STEMI group, whereas in patients with STEMI without COVID-19 in only 1 patient, p = 0.014. MACE were the most common outcome in the group with STEMI and COVID-19: there were 5 deaths and 4 hospitalizations due to non-fatal MI. In the COVID-19 group without STEMI, there were 4 deaths and 1 hospitalization due to non-fatal MI. In the STEMI group without COVID-19, no adverse cardiovascular events were observed during the follow-up period after inpatient treatment. An assessment of the odds ratio in patients with STEMI with COVID-19 and patients with COVID-19 without STEMI in the long-term follow-up period showed a significant association between the effect of the enlarged left atrium (LA) presence (OR 24.556; CI 2.752-219.100; p < 0.001), dilation of both atria (OR 13.750; CI 2.847–66.401; p = 0.001) and signs of pulmonary hypertension (PH) (OR 4.886; CI 1.211–19.715; p = 0.041) forecast the development of adverse cardiovascular events in the long-term follow-up period. 
Conclusions. Patients with STEMI and COVID-19 are at greater risk of MACE in the long term compared to patients with STEMI without COVID-19. LV myocardial remodeling, increased LVMi and decreased LVEF are common in patients with STEMI and COVID-19. The presence of LP dilation, dilation of both atria, and signs of PH in patients with COVID-19 is a risk factor for the development of adverse cardiovascular events.

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