Spectrum of Cardiac Manifestations in COVID-19

Abstract

Background: Information regarding the cardiac manifestations of COVID-19 is scarce. We performed a systematic and comprehensive echocardiographic evaluation of consecutive patients hospitalized with COVID-19 infection. Methods: 100 consecutive patients diagnosed with COVID-19 infection underwent complete echocardiographic evaluation within 24 hours of admission and were compared to reference values. Echocardiographic studies included left ventricular (LV) systolic and diastolic function, valve hemodynamics and right ventricular (RV) assessment, as well as lung ultrasound. A second exam was performed in case of clinical deterioration. Results: Thirty two patients (32%) had a normal echocardiogram at baseline. The most common cardiac pathology was RV dilatation and dysfunction (observed in 39% of patients), followed by LV diastolic dysfunction (16%) and LV systolic dysfunction (10%). Patients with elevated troponin (20%) or worse clinical condition did not demonstrate any significant difference in LV systolic function compared to patients with normal troponin or better clinical condition, but had worse RV function. Clinical deterioration occurred in 20% of patients. In these patients, the most common echocardiographic abnormality at follow-up was RV function deterioration (12 patients), followed by LV systolic and diastolic deterioration (in 5 patients). Femoral vein thrombosis (DVT) was diagnosed in 5 of 12 patients with RV failure. Conclusions: In COVID-19 infection, LV systolic function is preserved in the majority of patients, but LV diastolic and RV function are impaired. Elevated troponin and poorer clinical grade are associated with worse RV function. In patients presenting with clinical deterioration at follow-up, acute RV dysfunction, with or without DVT, is more common, but acute LV systolic dysfunction was noted in ≈20%.

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

“…HScTn is a vital prognostic marker in COVID-19, with multiple potential causes, including myocarditis, stress cardiomyopathy, coronary microvascular ischemia and tachycardiomyopathy [27]. Our findings are supported by a systematic echocardiographic study from Tel Aviv, which suggested that for the majority of patients admitted with COVID-19, RV rather than LV injury is the more likely explanation for a raised HScTn [28]. An echocardiographic study including 82 critical care patients has suggested pulmonary hypertension rather than RV dysfunction has a more robust association with increased in-hospital mortality, although the authors concede the presence of elevated pulmonary pressures are likely multifactorial and could relate to hypoxemia-related pulmonary vasoconstriction and increased PEEP [29].…”

Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

“…However, it cannot be excluded that patients (especially males [42]) who were more severely affected when presenting to the emergency department were sent directly to intensive care units, thus being missed in our analysis. Due to safety reasons, and according to current specific guidelines [20], transthoracic echocardiography was performed only in a subset of patients within the whole population; hence, we could not provide comprehensive data regarding echocardiographic findings; notwithstanding, our results are in line with previous research linking right ventricular dysfunction to increased levels of cardiac biomarkers in COVID-19 pneumonia [43]. Individuals affected by COVID-19 represent a heterogeneous group of patients, in which the time and location of data collection may lead to significant variation among different samples; hence, our results cannot be immediately translated to study populations characterized by largely different demographic and clinical characteristics.…”

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

“…COVID-19 results in acute respiratory distress syndrome (ARDS) 34 and is frequently associated with RV dysfunction, increased pulmonary resistance 35 , increased values of systolic pulmonary arterial pressure, increased RV afterload 36,37 , severe hypoxia, oxidative stress, and increased myocardial oxygen demand induced by ARDS 38 .…”

“…According to a recent systematic echocardiographic study, the most frequent abnormality induced by COVID-19 was RV dilation with or without dysfunction 35 . However, our results only showed RV dysfunction in patients with LGE.…”