Original article
Cardiac Abnormalities in COVID-19 and Relationship to Outcome

https://doi.org/10.1016/j.mayocp.2021.01.006Get rights and content

Abstract

Objective

To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19).

Methods

Retrospective cohort study that included consecutive inpatients with COVID-19 infection who underwent clinically indicated transthoracic echocardiography at 10 sites in the Mayo Clinic Health System between March 10 and August 5, 2020. Echocardiography was performed at bedside by cardiac sonographers according to an abbreviated protocol. Echocardiographic results, demographic characteristics, laboratory findings, and clinical outcomes were analyzed.

Results

There were 179 patients, aged 59.8±16.9 years and 111 (62%) men; events within 30 days occurred in 70 (39%) patients, including prolonged hospitalization in 43 (24%) and death in 27 (15%). Echocardiographic abnormalities included left ventricular ejection fraction less than 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) of 35 or greater mm Hg in 44 (44%) of 101 in whom it was measured. Myocardial injury, defined as the presence of significant troponin level elevation accompanied by new ventricular dysfunction or electrocardiographic abnormalities, was present in 13 (7%). Prior echocardiography was available in 36 (20%) patients and pre-existing abnormalities were seen in 28 (78%) of these. In a multivariable age-adjusted model, area under the curve of 0.81, prior cardiovascular disease, troponin level, D-dimer level, and RVSP were related to events at 30 days.

Conclusion

Bedside Doppler assessment of RVSP appears promising for short-term risk stratification in hospitalized patients with COVID-19 infection undergoing clinically indicated echocardiography. Pre-existing echocardiographic abnormalities were common; caution should be exercised in attributing such abnormalities to the COVID-19 infection in this comorbid patient population.

Abbreviations and Acronyms

AS
aortic stenosis
COVID-19
coronavirus disease 2019
ECMO
extracorporeal membrane oxygenation
GLS
global longitudinal strain
LV
left ventricular
LVEF
left ventricular ejection fraction
MR
mitral regurgitation
NSTEMI
non–ST-elevation myocardial infarction
Q
quartile
RRT
renal replacement therapy
RV
right ventricular
RWMSI
regional wall motion score index
RVSP
right ventricular systolic pressure
TR
tricuspid regurgitation
TTE
transthoracic echocardiography

Cited by (0)

Grant Support: This work was supported by a grant from the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.

Potential Competing Interests: The authors report no competing interests.

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