Echocardiography in Confirmed and Highly Suspected Symptomatic COVID-19 Patients and Its Impact on Treatment Change

Abstract

Background. COVID-19 interacts at multiple levels with the cardiovascular system. The prognosis of COVID-19 infection is known to be worse for patients with underlying cardiovascular diseases. Furthermore, the virus is responsible for many cardiovascular complications. Myocardial injury may affect up to 20% of the critically ill patients. However, echocardiography’s impact on the management of patients affected by COVID-19 remains unknown. Objectives. To explore echocardiography’s impact on the management of COVID-19 patients. Methods. This study was conducted from March 24th to April 14th, 2020, in a single center at Adolphe de Rothschild Foundation Hospital, Paris, France. All consecutive inpatients with laboratory and/or CT COVID-19 diagnosis were included in this study. Patients’ characteristics (clinical, biological, and imaging) and treatment change induced by echocardiography were collected and analyzed. Patients with and without treatment change induced by echocardiography were compared. Results. A total of 56 echocardiographies in 42 patients with highly suspected or confirmed COVID-19 were included in the final analyses. The median age was 66 (IQR 60.5–74). Echocardiography induced a treatment change in 9 cases (16%). The analyzed clinical data were not associated with any treatment change induced by echocardiography. D-dimer and Troponin levels were the only biological predictors of the induced treatment change. On echocardiography, higher systolic pulmonary arterial pressure and documented cardiac thrombi were associated with treatment changes in these patients. Conclusions. Echocardiography may be useful for the management of selected COVID-19 patients, especially those with elevated D-Dimer and Troponin levels, in up to 16% of patients.

Cardiac Abnormalities in COVID-19 Patients: Should a Cardiac Echocardiogram be Routine?

“…A prospective study by the ESC suggests that more than half of the transthoracic echocardiograms performed in patients with COVID-19 show abnormalities, including in patients without previous heart disease and particularly when there are elevated levels of natriuretic peptides and high-sensitivity troponin [5] . Treatment changes were seen in 16% [6] to 33% [5] of patients evaluated by transthoracic echocardiograms, with elevation of D-dimers and troponin being suggested as a predictor of such changes. The prognostic impact of these treatment changes is unclear.…”

Echocardiography in suspected coronavirus infection: indications, limitations and impact on clinical management

“…Echocardiographic results changed management for relatively few patients with COVID-19 in this study, which is consistent with what others have found. 13 Echocardiography should only be performed if there is an expected benefit in the management of the patient, and risk to healthcare workers and the patient should be carefully considered. In patients with suspected myocardial injury, further investigation may be warranted, as this is important for prognosis and may alter management for a select group of patients.…”

An exploration of the characteristics of COVID-19 patients referred to a central cardiology hospital with acute coronary syndrome

“… 1 Earlier investigation on COVID-19 patients indicated that the history of underlying cardiovascular disease(CVD) is a negative prognostic factor. 2 Accordingly, the case fatality rate in COVID-19 patients with no underlying disease is 0.9%, while comorbidities such as CVD, hypertension (HTN), and diabetes mellitus (DM) substantially increase the mortality rate. 2 At least 20% of critically ill COVID-19 patients experience cardiac injuries.…”

“… 2 Accordingly, the case fatality rate in COVID-19 patients with no underlying disease is 0.9%, while comorbidities such as CVD, hypertension (HTN), and diabetes mellitus (DM) substantially increase the mortality rate. 2 At least 20% of critically ill COVID-19 patients experience cardiac injuries. Of note, this infection can cause cardiac problems even in patients without a history of CVD.…”