Early echocardiographic findings in patients hospitalized for COVID-19 pneumonia: a prospective, single center study

Abstract

Background Cardiac dysfunction, mainly assessed by biomarker alterations, has been described in COVID-19 infection. However, there are still areas of uncertainty regarding its effective role in disease evolution. Aim of this study was to evaluate early echocardiographic parameters in COVID pneumonia and their association with severity disease and prognosis. Methods An echocardiographic examination was performed within 72 h from admission in 64 consecutive patients hospitalized for COVID-19 pneumonia in our medium-intensity care unit, from March 30th to May 15th 2020. Six patients were excluded for inadequate acoustic window. Results Fifty-eight consecutive patients were finally enrolled, with a median age of 58 years. Twenty-two (38%) were classifiable as severe COVID-19 disease. Eight out of 58 patients experienced adverse evolution (six died, two were admitted to ICU and received mechanical ventilation), all of them in the severe pneumonia group. Severe pneumonia patients showed higher troponin, IL-6 and d-Dimer values. No significant new onset alterations of left and right ventricular systolic function parameters were observed. Patients with severe pneumonia showed higher mean estimated systolic pulmonary artery pressure (sPAP) (30.7 ± 5.2 mmHg vs 26.2 ± 4.3 mmHg, p = 0.006), even if in the normality range values. No differences in echocardiographic parameters were retrieved in patients with adverse events with respect to those with favorable clinical course. Conclusion A mild sPAP increase in severe pneumonia patients with respect to those with milder disease was the only significant finding at early echocardiographic examination, without other signs of new onset major cardiac dysfunction. Future studies are needed to deepen the knowledge regarding minor cardiac functional perturbation in the evolution of a complex systemic disorder, in which the respiratory involvement appears as the main character, at least in non-ICU patients.

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 .…”

COVID-19 enfeksiyonunda yoğun bakımda BNP'nin prognostik bir biyobelirteç olarak yeniden tanımlanması

“…The effect of hypoxia on pulmonary artery pressure in pneumonia patients increases ventricular wall tension, and this may explain the elevation of BNP in pneumonia patients independent of heart failure 16,40 . High pulmonary artery pressure is also seen in COVID-patients, which is an indicator of poor prognosis and mortality 41,42 . This mechanism may explain the elevation of BNP levels in critically ill patients that resulted in mortality in our study.…”

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

“…In both critical and non-critical care settings, transthoracic echocardiography (TTE) is considered a frontline cardiovascular imaging tool in COVID-19 [333][334][335][336][337][338][339]. Abnormal TTE findings are common and alter clinical management in up to one third of cases [333,334].…”