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Pericardial Involvement in Patients Hospitalized With COVID-19
Quick Takes
- This is a prospective, single-center, observational study in which consecutive adult patients hospitalized with COVID-19 underwent echocardiography.
- The prevalence of pericardial effusions in patients hospitalized for COVID-19 is 14%, the vast majority of which are mild. Only 3.2% met criteria for pericarditis.
- Pericardial effusions were associated with certain aspects of COVID-19 disease severity such as pulmonary disease and RV dysfunction.
Study Questions:
What is the prevalence of pericardial effusions and its clinical implications in patients hospitalized with coronavirus disease 2019 (COVID-19)?
Methods:
This is a prospective, single-center, observational study in which consecutive adult patients hospitalized with COVID-19 from March 2020–September 2020 underwent echocardiography within 48 hours of admission regardless of the presence of a clinical indication. The authors examined the association between clinical, echocardiographic parameters and mortality at follow-up. They notably assessed for the incremental value of a pericardial infusion in predicting mortality.
Results:
The study included 530 patients (mean age 63 years, 62% men, 44% with severe COVID-19) who underwent echocardiography. Pericardial effusion was found in 75 (14%), with only 17 patients (3.2%) fulfilling the criteria for acute pericarditis. The vast majority of pericardial effusions were mild (96%), with only three moderate-size effusions. Pericardial effusion was independently associated with a higher modified early warning score, brain natriuretic peptide levels, and worse right ventricular (RV) function. Mortality at follow-up was 18.3% (97 deaths). All-cause mortality was higher in patients with a pericardial effusion compared to those without (33.3% vs. 15.8%, respectively, with a hazard ratio [HR] of 2.44). After adjusting for clinical characteristics and echocardiographic parameters, the association between pericardial effusion and mortality was heavily attenuated (adjusted HR, 1.96; 95% confidence interval, 0.89-4.09). Neither C-reactive protein (CRP) levels nor troponin I levels were associated with the presence of a pericardial effusion.
Conclusions:
The prevalence of pericardial effusions in patients hospitalized for COVID-19 is 14%, the vast majority of which are mild. Pericardial effusions are associated with worse pulmonary disease and RV dysfunction.
Perspective:
The authors have to be commended for this prospective study systematically assessing patients hospitalized with COVID-19 using echocardiography, as it clarifies the prevalence of pericardial effusions as well as other echocardiographic abnormalities (reported in an earlier study). This is important because earlier studies suggested a much higher prevalence of pericardial effusions, leading to major concern. The difference in prevalence may have been related to selection bias and severity of disease in earlier retrospective studies. Interestingly, the presence of pericardial effusions was not associated with CRP levels. While this may be interpreted as inflammation not playing a major role in leading to pericardial effusions, CRP level is not the optimal biomarker to quantify inflammation in COVID-19. Last, echocardiograms were performed within 48 hours of hospitalization, at a single time point. Development of pericardial effusions with progressive disease cannot be ruled out.
Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Pericardial Disease, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound
Keywords: Biomarkers, COVID-19, C-Reactive Protein, Diagnostic Imaging, Echocardiography, Heart Failure, Inflammation, Natriuretic Peptide, Brain, Pericardial Effusion, Pericarditis, Primary Prevention, Troponin I, Ventricular Dysfunction, Right, ACC22, ACC Annual Scientific Session
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