Time course of lung ultrasound findings in patients with COVID-19 pneumonia and cardiac dysfunction

Abstract

Background Lung ultrasound (LUS) is a valuable tool to predict and monitor the COVID-19 pneumonia course. However, the influence of cardiac dysfunction (CD) on LUS findings remains to be studied. Our objective was to determine the effect of CD on LUS in hospitalized patients with COVID-19 pneumonia. Material and methods Fifty-one patients with COVID-19 pneumonia participated in the study. Focused echocardiography (FoCUS) was carried out on day 1 to separate patients into two groups depending on whether they had FoCUS signs of CD (CD+ vs CD−). LUS scores, based on the thickness of the pleural line, the B-line characteristics, and the presence or not of consolidations, were obtained three times along the patient’s admission (D1, D5, D10) and compared between CD+ and CD− patients. A correlation analysis was carried out between LUS scores and the ratio of the arterial partial pressure of oxygen to the fraction of the inspired oxygen (P/F ratio). Results Twenty-two patients were CD+ and 29 patients were CD−. Among the CD+ patients, 19 were admitted to the intensive care unit (ICU), seven received invasive mechanical ventilation (IMV), and one did not survive. Among the CD− patients, 11 were admitted to the ICU, one received IMV and seven did not survive. CD+ patients showed a significantly lower P/F ratio than CD− patients. However, LUS scores showed no between-group differences, except for fewer subpleural consolidations in the upper quadrants of CD+ than on CD− patients. Conclusion In patients with COVID-19, CD contributed to a worse clinical course, but it did not induce significant changes in LUS. Our findings suggest that pathophysiological factors other than those reflected by LUS may be responsible for the differences in clinical condition between CD+ and CD− patients.

Lung Ultrasound in Adults and Children with COVID-19: From First Discoveries to Recent Advances

“…The authors found that LV dysfunction was observed in approximately 20% and RV dysfunction in approximately 30% of patients with acute SARS-CoV-2 infection and that age at presentation, previous lung disease, LDH, LVLS, and RVFWS were independently associated with in-hospital mortality. These new findings support the interest in an integrated evaluation of the lungs and cardiac ultrasound function to evaluate the patient’s prognosis, considering that respiratory insufficiency can be a multifactorial decision-making process [ 22 , 23 , 24 ]. However, the routine use of echocardiography among low-risk patients is not recommended.…”

Point-of-care ultrasound use in COVID-19: a narrative review

“…Patients with cardiac dysfunction on ultrasound were found to have lower PaO 2 /FiO 2 ratio compared to patients without cardiac dysfunction, leading to higher rates for intubation and ICU admission ( 136 ). In patients with COVID-19 and PE, those with a larger right ventricular diameter on ultrasound required oxygen support more often ( 137 ), and hence may be a potentially useful tool for risk stratification.…”

Sonography of the pleura

“…Another problem is that the expression of certain diagnostic artifacts of lung and pleural sonography, especially vertical artifacts, depends on the selected transducer (especially central frequency and bandwidth), instrument settings or presets, focus, time-gain compensation (TGC), and the use of artifact minimizing technologies (harmonic imaging, compounding). The available literature is limited and predominantly dates from the last 3 years 23 24 25 26 , which means that the International Consensus Guidelines published in 2012 were not yet able to provide any concrete recommendations 17 . International consensus recommendations from 2023 address the issue in detail and suggest the use of optimized LUS presets, but without detailing specifics 11 .…”

“…Presets, der Fokussierung und der Time-Gain-Compensation (TGC) sowie der Verwendung von artefaktminimierenden Technologien (Harmonic Imaging, Compounding) abhängig ist. Die dazu verfügbare Literatur ist begrenzt und stammt vorwiegend aus den letzten 3 Jahren 23 24 25 26 , sodass die 2012 publizierten internationalen Konsens-Guidelines noch keine konkreten Empfehlungen geben konnten 17 . Internationale Konsensempfehlungen aus dem Jahr 2023 gehen zwar detailliert auf das Thema ein und schlagen die Nutzung optimierter LUS-Presets vor, ohne allerdings deren Spezifika detailliert anzugeben 11 .…”