Echocardiographic Characteristics of Subjects With COVID-19: A Case Series

Abstract

Although coronavirus disease 2019 manifests in most cases with respiratory symptoms, other presentations can occur. Direct damage to the cardiovascular system has been reported and recently, acute myocardial injury has been identified as a risk factor for mortality. Transthoracic echocardiography is a non-invasive tool that allows the detection of myocardial damage with validated markers (left ventricular ejection fraction and global longitudinal strain). Herein, we present the echocardiographic findings in four patients with COVID-19. All cases had acute respiratory distress syndrome (100%). Three out of four had elevated levels of creatine kinase and creatine kinase myocardial band. One case had ventricular concentric remodeling (25%). All cases (100%) had altered ventricular function: two had a reduced ejection fraction (50%) and, of those available for global longitudinal strain analysis, all had abnormal global longitudinal strain (100%). One case was found to have a tricuspid vegetation of 12 × 10 mm with no other manifestation of endocarditis. All of our cases had left ventricular dysfunction as assessed by echocardiography. One of our patients had a vegetation in the tricuspid valve. Two of our cases had a reduced ejection fraction. The importance of acute cardiac injury in COVID-19 has recently been established. A recent study found it to be an independent risk factor for mortality in patients with this disease. Information regarding echocardiographic characteristics of this population is scarce. Further research to elucidate the impact of these characteristics on morbidity and mortality is urgently needed.

Echocardiographic Manifestations in COVID-19: A Review

“…It is unclear whether this finding was associated with SARS-CoV-2 infection, or represented actual bacterial endocarditis or the presence of thrombus. Other studies have reported the presence of tricuspid vegetations that disappeared in subsequent echocardiographic evaluation in patients with negative blood cultures [56]. The presence of valve vegetations was also described in autopsy findings for SARS-CoV patients [57].…”

Association between echocardiographic features, troponin levels, and survival time in hospitalized COVID-19 patients with cardiovascular events

“… 51 , 55 , 57 LV dysfunction, in the form of either wall motion abnormalities or reduced ejection fraction, has been reported in various studies. 7 , 18 , 53 – 57 , 64 The wall motion abnormalities in some patients were found to resemble stress-induced cardiomyopathy 7 , 54 , 57 , 58 , 61 , 64 , 66 Churchill et al reported resolution of LV dysfunction in 82% of patients who underwent a follow-up echocardiography after a median 14 days. 53 In the present study, LV diastolic dysfunction was a common echocardiographic finding, seen in 56% of the patients.…”

Long-Term Complications of Coronavirus Disease 2019; What the Oral Surgeon Needs To Know

“…Although disease outcomes of COVID-19 are worsened by a pre-existing cardiovascular disease, the associated high burden of systemic inflammation is thought to be the main factor that predisposes to the development of subclinical disorders or even causes de novo cardiovascular damage 15 . Approximately 1 in 5 patients with COVID-19 experiences de novo myocardial injury, which may remain as a chronic consequence of the disease, 16 or worse, could be identified as a cause of mortality 17 . Beyond myocardial injury, an interesting recent study on 4 cases of COVID-19 found that 1 patient, with no prior history of heart disease, developed a vegetation in the tricuspid valve and severe tricuspid regurgitation 17 .…”

“…Approximately 1 in 5 patients with COVID-19 experiences de novo myocardial injury, which may remain as a chronic consequence of the disease, 16 or worse, could be identified as a cause of mortality 17 . Beyond myocardial injury, an interesting recent study on 4 cases of COVID-19 found that 1 patient, with no prior history of heart disease, developed a vegetation in the tricuspid valve and severe tricuspid regurgitation 17 . It was noted that patients infected with SARS-CoV have also developed endocarditis with vegetations in previous reports 18 …”