Echocardiographic Findings in Patients With COVID-19 Pneumonia

Mahmoud‐Elsayed, Hani; Moody, William E.; Bradlow, William; Khan-Kheil, Ayisha Mehtab; Senior, J. M.; Hudsmith, Lucy; Steeds, Richard P.

doi:10.1016/j.cjca.2020.05.030

Cited by 156 publications

(220 citation statements)

References 6 publications

(5 reference statements)

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“…Patients of black race are more likely to have a positive D-dimer than whites in conventional thromboembolic disease [ 9 ]. Given the post-mortem data highlighting the role of diffuse pulmonary small vessel endothelialitis and thrombus formation [ 10 ], together with evidence that injury to the RV (dilatation and dysfunction) is the primary cardiac manifestation of COVID-19 on transthoracic echocardiography (TTE) [ [11] , [12] , [13] , [14] ], further investigation into the influence of ethnicity on the relationship between these biomarkers, echocardiographic findings and outcomes is warranted.…”

Section: Introductionmentioning

confidence: 99%

Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

Moody¹,

Mahmoud‐Elsayed²,

Senior³

et al. 2021

CJC Open

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Section: Introductionmentioning

confidence: 99%

Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

Moody¹,

Mahmoud‐Elsayed²,

Senior³

et al. 2021

CJC Open

Self Cite

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“…This finding is consistent with other echocardiographic reports of smaller series recently published. 5 , 6 In particular, about one-third of the patients had the S1Q3T3 pattern, in isolation or associated with a RBBB. Notably the prevalence of RBBB in the general age-matched population is <4%.…”

Section: Discussionmentioning

confidence: 98%

Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement

et al. 2020

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Aims Our aim was to describe the electrocardiographic features of critical COVID-19 patients. Methods and results We carried out a multicentric, cross-sectional, retrospective analysis of 431 consecutive COVID-19 patients hospitalized between 10 March and 14 April 2020 who died or were treated with invasive mechanical ventilation. This project is registered on ClinicalTrials.gov (identifier: NCT04367129). Standard ECG was recorded at hospital admission. ECG was abnormal in 93% of the patients. Atrial fibrillation/flutter was detected in 22% of the patients. ECG signs suggesting acute right ventricular pressure overload (RVPO) were detected in 30% of the patients. In particular, 43 (10%) patients had the S1Q3T3 pattern, 38 (9%) had incomplete right bundle branch block (RBBB), and 49 (11%) had complete RBBB. ECG signs of acute RVPO were not statistically different between patients with (n = 104) or without (n=327) invasive mechanical ventilation during ECG recording (36% vs. 28%, P = 0.10). Non-specific repolarization abnormalities and low QRS voltage in peripheral leads were present in 176 (41%) and 23 (5%), respectively. In four patients showing ST-segment elevation, acute myocardial infarction was confirmed with coronary angiography. No ST-T abnormalities suggestive of acute myocarditis were detected. In the subgroup of 110 patients where high-sensitivity troponin I was available, ECG features were not statistically different when stratified for above or below the 5 times upper reference limit value. Conclusions The ECG is abnormal in almost all critically ill COVID-19 patients and shows a large spectrum of abnormalities, with signs of acute RVPO in 30% of the patients. Rapid and simple identification of these cases with ECG at hospital admission can facilitate classification of the patients and provide pathophysiological insights.

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“…Furthermore, impaired RV function has been demonstrated by either echocardiography or CMR 11,31,32 . RV strain has been recommended to assess the RV function in clinical scenarios with suspected RV dysfunction 33 .…”

Section: Discussionmentioning

confidence: 99%

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiac magnetic resonance imaging

Wang

Jiang

et al. 2020

Preprint

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Background: Coronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiac magnetic resonance imaging (CMRI). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMRIMethods: A total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMRI examination in this study. The CMRI protocol consisted of black blood fat-suppressed T2 weighted imaging (BB-T2WI), T2 star mapping, left ventricle cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). Myocardium edema and LGE were assessed in recovered COVID-19 patients. The left ventricle (LV) and right ventricle (RV) function and LV mass were assessed and compared with normal controls.Results: Finally, 44 recovered COVID-19 patients and 31 normal controls were included in this study. No edema was observed in any patient. LGE was found in 13 patients. All LGE lesions were located in the middle myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased left ventricle peak global circumferential strain (LVpGCS), right ventricle peak global circumferential strain (RVpGCS), right ventricle peak global longitudinal strain (RVpGLS) as compared to non-LGE patients (p＜0.05), while no difference was detected between the non-LGE patients and normal controls.Conclusion: Myocardium injury existed in about 30% of COVID-19 patients. These patients had peak right ventricle strain that decreased at the 3-month follow-up. Cardiac MRI can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of left ventricle circumferential contraction dysfunction and right ventricular dysfunction.

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Echocardiographic Findings in Patients With COVID-19 Pneumonia

Cited by 156 publications

References 6 publications

Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiac magnetic resonance imaging

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