Observations on echocardiographic findings in patients with COVID-19

Abstract

Background The novel coronavirus (SARS-CoV-2) has created global havoc by causing Coronavirus Disease 2019 (COVID-19). Cardiovascular involvement in COVID-19 varies from troponin rise or arrhythmia/myocarditis to fulminant cardiogenic shock. There is limited data on echocardiographic findings in such patients. We aimed to assess abnormal echocardiographic findings and contributory factors in patients with COVID-19.Methods We performed retrospective analysis of COVID-19 positive patients who underwent a transthoracic echocardiogram (TTE) at Sandwell and West Birmingham (SWBH) NHS Trust between March 2020 and May 2020. Patients were compared based on TTE changes and divided into two groups (abnormal TTE and normal TTE).Results 66 out of 463 patients with COVID-19 had a TTE. 46 patients (69.7%) had abnormal findings on their TTE. Tricuspid regurgitation was the most common abnormality observed (26 (56.5%) patients), followed by aortic regurgitation (13 (28.3%) patients) and mitral regurgitation (12 (26.1%) patients). Haemoglobin and LDH were predictors of abnormal TTE (Hb OR: 0.97, p = 0.049, LDH, OR: 1.00, p = 0.03). Significantly more patients in the abnormal TTE group died during their inpatient stay compared to normal TTE (p = 0.01). Having an abnormal TTE was an independent predictor of death on regression analysis (OR: 0.229, p = 0.034).Conclusions This is the first detailed observational study looking at echocardiographic changes in admitted COVID-19 patients irrespective of disease severity. The most common abnormality was valve regurgitation. Patients with abnormal TTE were more likely to die in hospital.

Cardiovascular Manifestations in Echocardiography in Patients Recently Recovered From COVID-19 Infection

“…Tricuspid regurgitation was the most common finding followed by mitral and aortic regurgitation. These findings came in agreement with Khan et al (21) who showed that the most common abnormality was valve regurgitation, tricuspid regurgitation was the most common observed (56.5%), followed by aortic regurgitation (28.3%) and mitral regurgitation (26.1%). This could be due to direct injury to myocyte, fulminant myocarditis or myocardial infarction resulting in chordae rupture as reported by Khanduri et al (22) .…”

Prognostic Value of Echocardiography in Recovered COVID-19 Patients: Review Article

“…Significant valvular heart disease was associated with elevated sPAP concentrations (moderate or greater severity). According to the findings by Khan et al (15) the majority of patients with abnormal transthoracic echocardiography (TTE) had valvular heart disease but no further pathology.…”

“…Numerous studies have used troponin levels, ECG abnormalities, and echocardiography features to explain the COVID-19-related cardiac injury in detail (13)(14)(15) . There is no link between troponin and abnormal TTE, and the underlying causes of cardiac dysfunction as they relate to abnormal TTE are probably complicated.…”

Echocardiography in COVID-19 Pandemic

“…These valvular diseases more likely were present before the onset of SARS-CoV2 infection. A recent study regarding echocardiographic findings among COVID patients reported that half of them presented a significant tricuspid regurgitation followed by aortic regurgitation and mitral regurgitation 47 . Tricuspid regurgitation is the most common VHD reported in COVID-19 patients and its severity could directly reflect the impairment of the pulmonary circulation during the infection resulting in pulmonary hypertension, especially in patients with severe pneumonia and respiratory insufficiency 48 .…”