The utility of bedside echocardiography in critically ill COVID‐19 patients: Early observational findings from three Northern New Jersey hospitals

Abstract

Introduction Cardiovascular complications related to coronavirus disease 2019 (COVID‐19) have led to the need for echocardiographic services during the pandemic. The present study aimed to identify the echocardiographic findings in hospitalized COVID‐19 patients and their utility in disease management. Methods We included patients who were diagnosed with COVID‐19 using polymerase chain reaction and those who underwent echocardiographic examination during their hospitalization. Results Altogether, 45 patients were evaluated. The mean age was 61.4 ± 12.2 years. Hypertension (n = 29, 64%) and diabetes mellitus (n = 25, 55%) were the most common comorbidities followed by congestive heart failure (n = 11, 24%), coronary artery disease (n = 9, 20%), and valvular heart disease (n = 3, 7%). Eight patients (18%) showed evidence of myocardial injury, as suggested by elevated troponin levels. Brain natriuretic peptide was elevated in 14 patients (36%), and 14 patients had left ventricular dysfunction in the form of reduced ejection fraction (31%). Right ventricular (RV) dilatation was observed in six patients, and five patients had reduced RV ejection fraction. RV pressure and volume overload were observed in three patients. RV thrombus was observed in one patient. Pulmonary pressure was elevated in 10 patients (24%). Conclusion Two‐dimensional echocardiography can be an important bedside tool for the assessment of cardiovascular abnormalities and hemodynamic status of COVID‐19 patients.

Right Ventricular Damage in COVID-19: Association Between Myocardial Injury and COVID-19

“…Szekely et al ( 5 ) showed that RV dysfunction was more common in patients with elevated troponin levels and a poor clinical grade, whereas the total number of patients with an impaired LV function was relatively smaller. Notably, in several other studies, LV dysfunction was not rare in patients with COVID-19 ( 18 , 23 , 25 ). This discrepancy among studies may be due to differences in the study populations, but RV damage is still universally found by echocardiography in patients with COVID-19.…”

“…We summarized the results of recent cardiac imaging studies ( Table 2 ). Among patients with COVID-19-related myocardial injury, the proportion of RV dilatation ranged from 13.3 to 48.9% ( 5 , 6 , 17 , 20 , 23 ). RV dilatation associated with elevated D-dimer levels and C-reactive protein levels was more common in patients with COVID-19 ( 6 , 17 , 18 , 20 ).…”

“…Patients without pre-existing cardiovascular diseases are more likely to have normal echocardiography than those with pre-existing cardiovascular diseases ( 21 ). RV dysfunction is more common than LV dysfunction in COVID-19 ( 23 ). Patients with RV dysfunction had a higher rate of cardiac comorbidities compared with patients without RV dysfunction ( 37 ).…”

“…Patients with RV dysfunction had a higher rate of cardiac comorbidities compared with patients without RV dysfunction ( 37 ). The main reasons for performing echocardiography in the previous study were suspected heart failure and elevated cardiac biomarker concentrations ( 5 , 21 , 23 ). Independent predictors of RV abnormalities are suspected RV failure and moderate or severe COVID-19 symptoms ( 21 ).…”

A Rare Case of Myocarditis Mimicking ST-Elevation Myocardial Infarction

“…However, this is infrequently performed due to the invasive nature of the procedure and the probability of sampling errors caused by the characteristic patchy inflammation [ 2 , 10 ]. The more commonly performed studies include ECG, echocardiography, cardiac magnetic resonance imaging (CMRI) [ 11 ]. Markers of inflammation, viral serology, and cardiac biomarkers that include troponins and creatine kinase may also help confirm the diagnosis [ 1 , 9 ].…”