Cardiac Abnormalities in COVID-19 and Relationship to Outcome

Abstract

Objective: To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with coronavirus disease 2019 . Methods: Retrospective cohort study that included consecutive inpatients with COVID-19 infection who underwent clinically indicated transthoracic echocardiography at 10 sites in the Mayo Clinic Health System between March 10 and August 5, 2020. Echocardiography was performed at bedside by cardiac sonographers according to an abbreviated protocol. Echocardiographic results, demographic characteristics, laboratory findings, and clinical outcomes were analyzed. Results: There were 179 patients, aged 59.8AE16.9 years and 111 (62%) men; events within 30 days occurred in 70 (39%) patients, including prolonged hospitalization in 43 (24%) and death in 27 (15%). Echocardiographic abnormalities included left ventricular ejection fraction less than 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) of 35 or greater mm Hg in 44 (44%) of 101 in whom it was measured. Myocardial injury, defined as the presence of significant troponin level elevation accompanied by new ventricular dysfunction or electrocardiographic abnormalities, was present in 13 (7%). Prior echocardiography was available in 36 (20%) patients and pre-existing abnormalities were seen in 28 (78%) of these. In a multivariable age-adjusted model, area under the curve of 0.81, prior cardiovascular disease, troponin level, D-dimer level, and RVSP were related to events at 30 days. Conclusion: Bedside Doppler assessment of RVSP appears promising for short-term risk stratification in hospitalized patients with COVID-19 infection undergoing clinically indicated echocardiography. Pre-existing echocardiographic abnormalities were common; caution should be exercised in attributing such abnormalities to the COVID-19 infection in this comorbid patient population.

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

“…29 studies reported data about the prevalence of RVD 14 – 42 , while 7 reported about all-cause mortality according to RVD status 17 , 19 , 20 , 30 , 33 , 35 , 36 . 11 studies were held in Europe 16 , 18 – 21 , 33 – 36 , 38 , 40 , 8 in North America 23 , 25 , 26 , 28 , 29 , 37 , 41 , 42 , 3 in Asia 30 – 32 , and 7 in other geographical locations 14 , 15 , 17 , 22 , 24 , 27 , 39 , including 2 multinational studies 24 , 27 . Cohorts included were quite homogeneous in terms of mean age of the included patients (ranging from 52 years old to 68 years old); among sex, males were generally more represented than females (up to 84%).…”

“…The definition of RVD was heterogeneous across studies, both in terms of parameters and cut-offs used to defined RVD. 13 studies used a combination of several parameters 15 , 18 , 19 , 21 , 24 , 28 , 30 , 33 – 35 , 38 , 40 , 42 , 8 studies defined RVD according to TAPSE cut-off 14 , 16 , 22 , 23 , 31 , 32 , 36 , 39 , while other or unclear definitions of RVD was used in 8 studies 17 , 20 , 25 – 27 , 29 , 37 , 41 . In one study, a surrogate of Right Ventricular-Arterial uncoupling, which in turn relates the degree of RVD to the increase of pulmonary pressure, was addressed 20 .…”

Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID‐19: A systematic review

“…WMA reporting has been variable among studies with incidence ranging from 14% to 26% among patients with COVID-19 who underwent ECHO, 50,62 and has shown to correlate with biochemical injury of the myocardium. 63,64 WMA was more frequently observed in the mid and apical segments followed by basal segments. 63,64 EKG changes are common, but do not always exist in patients with WMAs.…”

“…63,64 WMA was more frequently observed in the mid and apical segments followed by basal segments. 63,64 EKG changes are common, but do not always exist in patients with WMAs. The most common EKG change was T wave inversion.…”

“…The most common EKG change was T wave inversion. 46,63 The most commonly adjudicated diagnosis was myocarditis and/or stress cardiomyopathy, followed by NSTEMI. 63…”