Clinical conditions and echocardiographic parameters associated with mortality in COVID‐19

Abstract

Background Coronavirus disease 2019 (COVID‐19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in‐hospital mortality in COVID‐19. Methods This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID‐19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in‐hospital mortality was assessed through multivariable logistic regression and competing risk analyses. Results Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID‐19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In‐hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < .001), tricuspid annular plane systolic excursion (TAPSE, P < .001) and ARDS ( P < .001) were independently associated with in‐hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95‐14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15‐8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50‐6.59). Conclusions TTE might be a useful tool in risk stratification of patients with COVID‐19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.

Prognostic Implications of Right Ventricular Function and Pulmonary Pressures Assessed by Echocardiography in Hospitalized Patients with COVID-19

“…In a previous study by our register, we have demonstrated that PE was a relatively common complication in hospitalized patients with COVID-19 and was associated with a poorer outcome [31]. Although associated with in-hospital mortality [32], in the present analysis, LVEF did not correlate with PE after adjustment for PAPS and TASE/PASP values, supporting the importance of these measures for PE risk stratification in this population.…”

Cardiovascular System during SARS-CoV-2 Infection

“…We used 23 articles in this section. Cardiac injury was a crucial and independent risk factor for mortality in COVID-19-infected patients [12,[21][22][23] and mortality was usually higher in the cardiac injury group [7,9,[23][24][25]. Patients with cardiac injury were older [7,11,22,26], had more comorbidities [22,25,26], were mostly male [10,22], had more serious disease [7,22,23] or were more likely to require mechanical ventilation [21,22].…”

Promoting a Syndemic Approach for Cardiometabolic Disease Management During COVID-19: The CAPISCO International Expert Panel

“…Since these first observations it is become clear that the same cytokines that induce aberrant endothelial function may also trigger the acute phase response, which, in combination with local endothelial dysfunction, can lead to clinical consequences ( 14 ); indeed, inflammatory cytokines have a major role in both diabetes and cardiovascular diseases ( 19 ). Other authors have shown that COVID-19 is associated with myocardial damage such as myocarditis, arrhythmia and reduced left ventricular ejection fraction ( 20 ), all of which are associated to increased mortality risk ( 21 ). Plasma cardiac biomarkers, such as high sensitivity troponin, creatine kinase and N-terminal pro-B-type natriuretic peptide, are also associated with COVID-19 severity in adults and children ( 22 , 23 ).…”