Cardiac Structural and Functional Characteristics in Patients with Coronavirus Disease 2019: A Serial Echocardiographic Study

Abstract

BACKGROUND: Increasing attention has been paid to cardiac involvement in patients with coronavirus disease 2019 ). Yet, scarce information is available regarding the morphological and functional features of cardiac impairments in these patients. METHODS:We conducted a prospective and serial echocardiographic study to investigate the structural and functional cardiac changes among COVID-19 patients admitted to the intensive care unit (ICU). From January 21 to April 8, 2020, a total of 51 ICU patients (31 critically ill and 20 severely ill) with confirmed COVID-19 were monitored by serial transthoracic echocardiography examinations. Outcomes were followed up until April 8, 2020. RESULTS:Of 51 ICU patients, 33 (64.7%) had cardiovascular comorbidities. Elevations of levels of cardiac biomarkers including high-sensitivity cardiactroponin-I (hs-cTnI) and brain natriuretic peptide were observed in 62.7% and 86.3% of patients, respectively. Forty-two (82.3%) had at least one left-heart and/or right-heart echocardiographic abnormality. The overall median left ventricular ejection fraction (LVEF) was 65.0% (IQR 58.0-69.0%), with most (44/86.3%) having preserved LVEF. Sixteen patients (31.4%) had increased pulmonary artery systolic pressure, and 14 (27.5%) had right-ventricle (RV) enlargement. During the study period, 12 (23.5%) patients died. LVEF was comparable between survivors and non-survivors, while non-survivors had more often pulmonary hypertension (58.3%

Observations on echocardiographic findings in patients with COVID-19

“…Participants in our groups were well-matched for age, sex and comorbidities. The commonest echocardiogram abnormality noted in our study was TR, similar to ndings from another study (31), and under one third of our patients demonstrated RV dysfunction. The latter could be secondary to the acute respiratory distress syndrome seen in critically ill COVID-19 patients, which results in RV systolic dysfunction (8,32,33).…”

“…Anecdotal evidence has demonstrated that elevation of PASP and then a sudden depreciation in COVID-19 fulminant myocarditis was likely linked to right heart functional decline secondary to sustained overload (43). In concordance with other studies, elevated PASP and right heart enlargement was signi cantly predictive of mortality (31). In fact, taking into consideration the crucial role of right heart function, the German Society of Cardiology concluded that optimum RV functioning was essential for COVID-19 patients' prognosis (44).…”

Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis

“…Four studies were excluded due to unavailability of the full-text. Finally, 56 papers ( [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] ) entered into meta-analysis for primary outcomes (mortality and ICU admission) and 198 papers [ 16 , 18 , [21] , [22] , [23] , [24] , [25] , [26] ,…”