Clinical outcome analysis in patients with COVID 19 using echocardiography and biochemical markers

Al Barjas, M; Lancioni, M; Eley, A; Catibog, J

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND AND PURPOSE Cardiac involvement in patients with COVID-19 is still unclear. We made a systematic echocardiographic and biochemical assessment of patients admitted with COVID-19 infection to assess correlation with various clinical outcomes. METHODS: We prospectively assessed 119 consecutive COVID-19 positive in-patients with full echocardiography studies, including left ventricle (LV) systolic function, right ventricle (RV) basal dimension and systolic function using Tricuspid Annular Plane Systolic Excursion (TAPSE) and systolic pulmonary artery pressure (SPAP). We excluded all patients with known left ventricular systolic dysfunction (LVSD) prior to admission. We also recorded laboratory biochemical findings including troponin-T, D-dimer and NT-proBNP levels. We carried out correlation analyses of the echocardiography and the laboratory biochemical findings with various clinical outcomes including mortality, length of stay (LOS), admission to Intensive Care Unit (ICU) and the three month re-admission rates. RESULTS: 119 patients (38% female); age range 35 to 96 years (mean 71, median 73). 37 (31%) patients died during hospital admission. The mean LOS for surviving patients was 32 days. 20 (17%) patients had significant LSVD (by biplane Simpson method, EF cut off 45%), 31 (26%) patients had RV dilatation, 28 patients (24%) had RV systolic dysfunction by TAPSE and 41 (35%) patients had raised pulmonary artery pressures. There was a weak Pearson’s correlation between mortality and LVSD (0.184, p 0.046), a moderate correlation with RVSD (0.303, p 0.001) and RV dilatation (0.231, p 0.012). Raised troponin-T and NT-proBNP levels correlated moderately with mortality (0.254, p 0.013 and 0.253, p 0.02 respectively). D-dimer levels did not correlate with mortality or any of the other clinical outcomes. Raised troponin-T levels had moderate correlation with admission to ICU and LOS (0.210, p 0.043 and 0.267, p 0.01 respectively). SPAP in isolation did not correlate with any of the clinical outcomes. None of the echocardiography or laboratory biochemical variants correlated with re-admission rates. CONCLUSION: In our cohort of patients with COVID-19 infection there is a weak to moderate mortality correlation with LV function, RV function and RV size. Laboratory biochemical markers especially troponin-T correlated more widely and moderately with clinical outcomes.