Clinical echocardiography does not indicate cardiac dysfunction in critically ill Covid-19 patients

Isackson, H.; Larsson, A.; Lipcsey, M.; Frithiof, R.; Flachskampf, F. A.; Hultstrom, M.

Aims: We aimed to investigate the acute effects of severe SARS-CoV-2 on myocardial function. Methods and Results: This is an observational study generated from the first 79 patients admitted to intensive care in Uppsala due to respiratory failure with SARS-CoV-2 infection, during the first wave in 2020, included in the PRONMED study. From this group 34 underwent echocardiographic examination of which 25 were included in the study, and compared to 44 non-echo patients. Demographic analysis compared standard parameters and previous morbidities between the echo and non-echo group. Standard echocardiographic parameters were analysed indicating a reduced left ventricular function as assessed by global longitudinal strain and very discrete increases in wall thickness in the group as a whole. A group comparison between the outcomes survival and death was carried out. Right sided dimensions and functional parameters did not indicate major strain. An increased maximum tricuspid valve regurgitation velocity indicating increased pulmonary arterial pressure was significantly associated with death, but failed to maintain significance when corrected for multiple comparison. Biochemical cardiac markers and D-dimer correlated to initiation of echocardiography and mortality. Tricuspid regurgitation maximum velocity was positively correlated with maximum troponin I. Conclusion: These results suggests that there is no clear negative effect on cardiac function in critical SARS-CoV-2 infection. There are indications that pulmonary pressure elevation carries a negative predictive outcome suggesting pulmonary disease as the major driver of mortality. Cardiac biomarkers as well as D-dimer carry a predictive outcome value.