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Cardiac Manifestations in COVID-19: Echocardiographic Study
Quick Takes
- The most frequent abnormality in COVID-19 was RV dilation with or without dysfunction, likely due to pulmonary parenchymal or vascular disease.
- Overall, given the risk of infection spread, routine echocardiography for all patients with COVID-19 infection does not seem warranted.
- Among clinically deteriorating patients, an echocardiogram can be useful in identifying etiology of cardiac injury and possibly targeted treatment.
Study Questions:
What is the frequency of cardiac abnormalities in coronavirus disease 2019 (COVID-19)?
Methods:
The investigators included 100 consecutive patients diagnosed with COVID-19 infection who underwent complete echocardiographic evaluation within 24 hours of admission and were compared to reference values. Echocardiographic studies included left ventricular (LV) systolic and diastolic function, valve hemodynamics and right ventricular (RV) assessment, as well as lung ultrasound. A second exam was performed in case of clinical deterioration. Cox proportional hazards models for mortality or clinical deterioration as endpoints allowed for calculation of hazard ratios of baseline echocardiographic parameters.
Results:
Thirty-two patients (32%) had a normal echocardiogram at baseline. The most common cardiac pathology was RV dilatation and dysfunction (observed in 39% of patients), followed by LV diastolic dysfunction (16%) and LV systolic dysfunction (10%). Patients with elevated troponin (20%) or worse clinical condition did not demonstrate any significant difference in LV systolic function compared to patients with normal troponin or better clinical condition, but had worse RV function. Clinical deterioration occurred in 20% of patients. In these patients, the most common echocardiographic abnormality at follow-up was RV function deterioration (12 patients), followed by LV systolic and diastolic deterioration (in five patients). Femoral vein thrombosis (DVT) was diagnosed in 5 of 12 patients with RV failure.
Conclusions:
The authors concluded that in COVID-19 infection, LV systolic function is preserved in the majority of patients, but LV diastolic and RV function are impaired.
Perspective:
This cohort study reports that in patients with COVID-19 infection, one third had normal echocardiography. Among those with abnormal echo, systolic LV dysfunction was uncommon, seen in <10%. The most frequent abnormality was RV dilation with or without dysfunction, likely due to pulmonary parenchymal or vascular disease. During hospitalization, 20% of patients experienced clinical deterioration, and in these patients, a second echocardiogram showed further deterioration of RV parameters, probably related to increased pulmonary pressures, with or without DVT. Overall, given the risk of infection spread, routine echocardiography for all patients with COVID-19 infection does not seem warranted. However, an echocardiogram can be useful in management of deteriorating patients, possibly permitting identification of etiology and prompt targeted treatment.
Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Chronic Heart Failure, Echocardiography/Ultrasound
Keywords: Coronavirus, COVID-19, Diagnostic Imaging, Dilatation, Echocardiography, Heart Failure, Heart Failure, Systolic, Heart Failure, Diastolic, Primary Prevention, severe acute respiratory syndrome coronavirus 2, Troponin, Ultrasonography, Vascular Diseases, Ventricular Dysfunction, Ventricular Dysfunction, Right, Ventricular Dysfunction, Left
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