Introduction
The incidence, characteristics, and prognosis of pulmonary embolism (PE) in Coronavirus disease 2019 (COVID-19) have been poorly investigated.
We aimed to investigate the prevalence and the correlates with the occurrence of PE as well as the association between PE and the risk of mortality in COVID-19.
Methods
Retrospective multicenter study on consecutive COVID-19 patients hospitalized at 7 Italian Hospitals. At admission, all patients underwent medical history, laboratory and echocardiographic evaluation.
Results
The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); PE was diagnosed in 32 cases (14%). Patients with PE were hospitalized after a longer time since symptoms onset (7 IQR 3–11 days, 3 IQR 1–6 days;
p
= 0.001) and showed higher D-dimers level (1819 IQR 568–5017 ng/ml vs 555 IQR 13–1530 ng/ml;
p
< 0.001) and higher prevalence of myocardial injury(47% vs 28%,
p
= 0.033). At multivariable analysis, tricuspid annular plane systolic excursion (TAPSE; HR = 0.84; 95% CI 0.66–0.98;
p
= 0.046) and systolic pulmonary arterial pressure (sPAP; HR = 1.12; 95% CI 1.03–1.23;
p
= 0.008) resulted the only parameters independently associated with PE occurrence. Mortality rates (50% vs 27%;
p
= 0.010) and cardiogenic shock (37% vs 14%;
p
= 0.001) were significantly higher in PE as compared with non-PE patients. At multivariate analysis PE was significant associated with mortality.
Conclusion
PE is relatively common complication in COVID-19 and is associated with increased mortality risk. TAPSE and sPAP resulted the only parameters independently associated with PE occurrence in COVID-19 patients.
Background
Coronavirus disease 2019 (COVID‐19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in‐hospital mortality in COVID‐19.
Methods
This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID‐19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in‐hospital mortality was assessed through multivariable logistic regression and competing risk analyses.
Results
Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID‐19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In‐hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF,
P
< .001), tricuspid annular plane systolic excursion (TAPSE,
P
< .001) and ARDS (
P
< .001) were independently associated with in‐hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95‐14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15‐8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50‐6.59).
Conclusions
TTE might be a useful tool in risk stratification of patients with COVID‐19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.
In hypertensive subjects with preserved LV EF, parameters of longitudinal LV systolic mechanics may not reflect the LV myocardial contractility status in steady-state conditions under short-term treatment with beta1-block.
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