BACK

The Spectrum of Cardiac Manifestations in Coronavirus Disease 2019 (COVID-19) – a Systematic Echocardiographic Study.

Background:

  • Cardiac complications of COVID – 19 have been described on the basis of elevated troponin and clinical findings.
  • No detailed evaluation of cardiac function by echocardiography has been described to identify the specific functional impairments that occur in patients with COVID – 19 hospital admission.

Study Goal:

  • To identify the frequency and types of echocardiographic findings in patients with COVID – 19 infection.

Key Points:

  • Consecutive echocardiograms were performed within 24 hrs. on admission for 100 adult pts admitted with COVID – 19 diagnosed by assay positive respiratory samples for SARS-CoV-2 virus.
  • Echocardiograms were repeated for patients with clinical deterioration defined as death, respiratory, hemodynamic or cardiac deterioration.
  • Symptoms on admission were most commonly respiratory followed by fever, chest pain and fatigue.
  • Seventy-two percent of pts had comorbidities: In order of frequency – Hypertension, diabetes, obesity and coronary artery disease.
  • Lab markers of disease were: Troponin I (20%), CRP (87%), BNP (30%) and D-dimer (58%).
  • Baseline echo cardiac parameters
    • Normal LVEF – 90% of pts
    • Normal LV filling pressures – 80%
    • RV dilatation – 39%
  • Baseline echo was normal in 32% of patients.
  • In (20%) pts with clinical deterioration
    • RV dilatation and dysfunction were present in 12/20 (60%) pts.
    • DVT present in 5/12 (42%) of pts with RV failure
    • LV dysfunction – 5 pts.

Summary

  • Baseline Echo normal in 1/3.
  • LVEF is not usually impaired.
  • LV dysfunction present in 10% patients
  • Clinical deterioration seen in 20% of patients.
  • Clinical deterioration most commonly associated with reduced right heart function in which case an echo can be important for patient management.

Final Comments:

  • The authors recommend echocardiograms only for deteriorating conditions, not as a routine, but this recommendation is directed at staff protection and the concern about cleaning equipment between cases for overall patient and staff safety.
  • This study again emphasizes the importance of assessing heart function by echocardiography and the significance of RV dysfunction in the cardiac deterioration of severe COVID – 19 disease.