Value of standard echocardiography at the bedside for COVID-19 patients in intensive care units: a Japanese single-center analysis

Abstract

Purpose In the era of COVID-19, those special settings or indications for which standard transthoracic echocardiography (TTE) can safely produce benefits or advantages over minimized ultrasound imaging procedures need to be identified. Thus, the purpose of this study was to conduct a retrospective analysis with offline comprehensive conventional measurement of bilateral heart function and develop an appropriate prognostic model for in-hospital death. Methods We performed a retrospective analysis of 37 consecutive patients with COVID-19, confirmed by real-time reverse-transcriptase polymerase chain reaction assay, who had undergone clinically indicated standard two-dimensional echocardiographic studies in intensive care wards. Offline comprehensive measurement was also performed. We further integrated the echocardiographic findings as paired evidence of vital organ involvement (possible respiratory distress assessed using right ventricular functional parameters, possible myocardial injury assessed using increased wall thickness, effusion or asynergy) and circulatory failure (suspected low flow status assessed using stroke volume index, suspected congestion assessed using elevated right or left atrial pressure). We evaluated its value for in-hospital death along with other echocardiographic findings. Results The most common features included a normal-sized left atrium and left ventricle with preserved left ventricular ejection fraction, despite deteriorated left ventricular flow volume. Less frequent findings, such as abnormalities in the right heart and left ventricular abnormalities suggesting myocarditis, were observed. Although the single echocardiographic parameters failed to show predictive values for in-hospital death, integration of the echocardiographic findings suggested predictive value ( p = 0.04, odds ratio: 12.28). Conclusion Standard TTE at the bedside with offline comprehensive conventional measurement may provide prognostic information that is valuable for the management of patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s10396-021-01122-1.

Right ventricular free wall longitudinal strain assessment using offline speckle tracking in COVID-19 patients requiring intensive medical care

“…The exclusion criteria were: patients younger than 18 years of age, patients on extracorporeal membranous oxygenation (ECMO) at the time of TTE, and patients with poor TTE image quality or incomplete TTE visualization due to limited acoustic windows. The study site, which was established as a private educational hospital founded by the Tokai University School of Medicine, serves as a medical institution authorized to treat patients with Japanese national health insurance coverage for regional tertiary care and provides medical care for COVID-19 patients with respiratory failure requiring oxygen administration (oxygen saturation of peripheral artery ≤ 93% on room air) in accordance with the instructions and requests from the regional government, as previously described [ 10 ]. All the patients with COVID-19 were transferred or referred from other medical institutions under the medical control of the local authorities and hospitalized in dedicated intensive care wards.…”

“…As previously described [ 10 ], all standard TTEs were performed at the bedside with patients in the left lateral decubitus, supine, or sitting positions, in quarantined intensive care rooms for COVID-19 using a dedicated ultrasound machine (Aplio a/Verifia; CANON Medical Systems Corp., Ohtahara-Shi, Japan) by a single operator with full personal protective equipment, following the medical biosafety guidelines for TTE [ 13 ]. All images were then transferred via an institutional wireless network to the video server of the medical ultrasound laboratory (PrimeVitaPlus; NIHON KOHDEN Corp., Shinjuku-ku, Japan).…”