ABC Imagem Cardiovasc. 2026; 39(3): e20260051
Serial Echocardiographic Assessment of Right Ventricular Function and Its Association With Functional Capacity, Dyspnea, and Pulmonary Diffusion in Post-COVID-19 Survivors
DOI: 10.36660/abcimg.20260051i
Introduction
Post-COVID-19 is characterized by new or persistent symptoms that typically develop within 3 months after acute SARS-CoV-2 infection, persist for at least 2 months, and substantially affect daily functioning. Dyspnea, reduced exercise tolerance, and fatigue are among the most common manifestations, suggesting that persistent cardiopulmonary abnormalities may contribute to long-term functional impairment., However, these symptoms are multifactorial and are often inadequately explained by abnormalities within a single organ system, which underscores the need for integrated phenotyping encompassing cardiac, pulmonary, and functional domains.,
Cardiac involvement in COVID-19 ranges from overt myocardial injury to subclinical myocardial dysfunction. The right ventricle (RV) is particularly vulnerable because of its sensitivity to acute increases in pulmonary vascular load resulting from hypoxic pulmonary vasoconstriction, thromboinflammation, microvascular dysfunction, the effects of invasive mechanical ventilation (IMV), and acute respiratory distress syndrome. During the acute phase of COVID-19, RV dysfunction — including abnormalities identified by 2D speckle-tracking echocardiography (2D-STE)-derived RV longitudinal strain — has consistently been associated with adverse clinical outcomes and mortality., A Brazilian systematic review with meta-analysis of hospitalized patients with COVID-19 reported a high prevalence of echocardiographic abnormalities, with pooled estimates of left ventricular and RV systolic dysfunction of 25% and 17%, respectively, highlighting the clinical value of cardiac imaging during the acute phase. 2D-STE provides a sensitive, reproducible assessment of RV mechanics, and RV free wall longitudinal strain (RVFWLS) can identify subtle systolic dysfunction even when conventional indices, such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and tricuspid annular systolic velocity (S′), remain within normal reference ranges. Furthermore, normative data demonstrate clinically meaningful variation in RVFWLS according to age and sex, emphasizing the importance of contextual interpretation and longitudinal assessment.
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