Comprehensive Echocardiographic Findings in Critically Ill COVID-19 Patients With or Without Prior Cardiac Disease

Abstract

Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. PurposeCoronavirus disease 2019 (COVID-19) presents with a spectrum of disease severity, the most serious cases requiring intensive care. Echocardiography is a front-line tool in evaluating cardiovascular complications of COVID-19 in the intensive care unit (ICU); we analyzed transthoracic echocardiograms obtained from this patient population with state-of-the-art ultrasound technology. MethodsAll patients with COVID-19 requiring ICU admission on whom a transthoracic echocardiogram was obtained were included in the study. Focused transthoracic protocols were performed by experienced sonographers. Echocardiographic variables, including speckle-tracking echocardiography, were collected and analyzed. Clinical information was obtained from the electronic medical record. Patients were followed until discharge. ResultsOf 52 total patients (mean age: 59.9 ± 11.6 years), 59.6% were male and 15 (29%) had known prior cardiac disease. Cardiac complications identified on echocardiography were prevalent, occurring in 55.7% of patients. Patients with known prior cardiac disease were more likely to have new or worsening left ventricular dysfunction. Right ventricular dysfunction was the most common abnormality (assessed qualitatively in 18 cases and with advanced echocardiographic methods in 34 cases). Known prior cardiac disease, right ventricular enlargement, and pulmonary hypertension were significantly associated with morbidity and mortality. ConclusionsPatients requiring intensive care for COVID-19 face significant morbidity and mortality, and cardiac complications occur in the majority of patients admitted to the ICU with COVID-19. Those with known prior cardiac disease fare worse, and other echocardiographic findings (right ventricular enlargement, pulmonary hypertension) are also associated with worse outcomes. State-of-the-art echocardiography performed by experienced sonographers can be critical to identifying cardiac complications and guiding ICU strategy.

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

“…29 studies reported data about the prevalence of RVD 14 – 42 , while 7 reported about all-cause mortality according to RVD status 17 , 19 , 20 , 30 , 33 , 35 , 36 . 11 studies were held in Europe 16 , 18 – 21 , 33 – 36 , 38 , 40 , 8 in North America 23 , 25 , 26 , 28 , 29 , 37 , 41 , 42 , 3 in Asia 30 – 32 , and 7 in other geographical locations 14 , 15 , 17 , 22 , 24 , 27 , 39 , including 2 multinational studies 24 , 27 . Cohorts included were quite homogeneous in terms of mean age of the included patients (ranging from 52 years old to 68 years old); among sex, males were generally more represented than females (up to 84%).…”

Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID‐19: A systematic review

“…RVFAC was not significantly different between patients with severe and non-severe COVID-19, 44,46 nor survivors, and non-survivors. 47,55,56 However, RVFAC was found to be lower in COVID-19 patients with myocardial injury when compared with COVID-19 patients without myocardial injury. 57,58 Also, RVFAC does not seem to be significantly decreased even in COVID-19 patients with acute cor-pulmonale as compared with those with no acute cor-pulmonale.…”

“…70 However, in other studies among COVID-19 patients RVFAC was not significantly different between survivors compared with non-survivors. 47,55,56 Finally, a study by D'Alto et al demonstrated that right ventriculararterial uncoupling expressed as TAPSE/PASP is an independent predictor of mortality in COVID-19 patients. 29 With regards to LV parameters, mortality was found to be increased in patients who had reduced LV longitudinal strain (LS), left ventricular stroke volume index (LVSVi), cardiac index and tissue Doppler S' (systolic wave) velocity.…”

COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases

“…Prior cardiac disease, right ventricular enlargement, and pulmonary hypertension were all associated with morbidity and mortality in these COVID-19 patients. [ 74 ]…”