Echocardiographic Characteristics and Outcome in Patients With COVID-19 Infection and Underlying Cardiovascular Disease

Abstract

Background: The cardiac manifestations of coronavirus disease 2019 (COVID-19) patients with cardiovascular disease (CVD) remain unclear. We aimed to investigate the prognostic value of echocardiographic parameters in patients with COVID-19 infection and underlying CVD.Methods: One hundred fifty-seven consecutive hospitalized COVID-19 patients were enrolled. The left ventricular (LV) and right ventricular (RV) structure and function were assessed using bedside echocardiography.Results: Eighty-nine of the 157 patients (56.7%) had underlying CVD. Compared with patients without CVD, those with CVD had a higher mortality (22.5 vs. 4.4%, p = 0.002) and experienced more clinical events including acute respiratory distress syndrome, acute heart injury, or deep vein thrombosis. CVD patients presented with poorer LV diastolic and RV systolic function compared to those without CVD. RV dysfunction (30.3%) was the most frequent, followed by LV diastolic dysfunction (9.0%) and LV systolic dysfunction (5.6%) in CVD patients. CVD patients with high-sensitivity troponin I (hs-TNI) elevation or requiring mechanical ventilation therapy demonstrated worsening RV function compared with those with normal hs-TNI or non-intubated patients, whereas LV systolic or diastolic function was similar. Impaired RV function was associated with elevated hs-TNI level. RV function and elevated hs-TNI level were independent predictors of higher mortality in COVID-19 patients with CVD.Conclusions: Patients with COVID-19 infection and underlying CVD displayed impaired LV diastolic and RV function, whereas LV systolic function was normal in most patients. Importantly, RV function parameters are predictive of higher mortality.

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

“…Although, some studies reported TAPSE to be significantly decreased in critically ill COVID-19 patients, more profoundly affected in severe ARDS as compared with mild ARDS, 47,[50][51][52][53] other studies demonstrated no difference in TAPSE between mild forms and more severe infections. 48,54…”

Echocardiographic assessment of the right ventricle in COVID-19: a systematic review

“…Authors hypothesized that their findings might be attributable to direct cardiac involvement or a sign of systemic extension of the viral disease. TAPSE was a good predictor of mortality both in samples with low [46,47] and high [48] rates of intubated patients and showed correlation with D-dimer and increased cardiac troponins [38,50].…”

“…Similar to TAPSE and S′ wave, RVFAC appears to be lower in severe patients [22], in subjects at 30-day followup [39], and correlated to D-dimer [22,49,50]. If evaluated as a binary variable based on 35% cut-off for RV dysfunction, RVFAC has been shown to be predictive of mortality [47,54]. Interestingly, in a study assessing RV dysfunction (TAPSE < 17 mm and/or RVFAC < 35%), RVFAC-based dysfunction was found to be more frequent than TAPSEbased dysfunction [49], possibly explained by the marked reduction in radial RV systolic function but relative preservation of longitudinal shortening, as elucidated by another study [27].…”

“…The correlation between troponin elevation and parameters of RV dysfunction has been evaluated [20,22,33,47,54]. A study including 305 subjects by Giustino et al [37] identified myocardial injury as an independent risk factor for mortality, but only when major abnormalities were detected by TTE, particularly RV dysfunction (26.3%, determined by combination of visual assessment, TAPSE < 17 mm, S′ < 9.5 cm/s), LV wall motion abnormalities (23.7%), and LV global dysfunction (18.4%).…”

“…Thus, high RV pressure produces RV myocardial stress and troponin release [69]. Increased levels of NT-ProBNP, the gold-standard biomarker of right and LV stretching in PH and/or heart failure, are commonly observed in COVID-19 patients [43,47,58].…”