Cardiac Abnormalities in COVID-19 and Relationship to Outcome

Krishna, Hema; Ryu, Alexander J.; Scott, Christopher G.; Mandale, Deepa R.; Naqvi, Tasneem Z.; Pellikka, Patricia A.

Objective To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with COVID-19. Methods Retrospective cohort study that included 179 consecutive inpatients with COVID-19 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, demographics, laboratory findings, and clinical outcomes were analysed. Results Of the 179 patients, age 59.8± 16.9 years and 108 (60%) 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 < 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) >35 mm Hg in 44 (25%). Myocardial injury, defined as the presence of significant troponin elevation accompanied by new ventricular dysfunction or electrocardiographic abnormalities, was present in 13 (7%). Prior echocardiography was available in 36 (20%) and pre-existing abnormalities were seen in 28 (78%) of these. In a multivariable age-adjusted model, AUC 0.81, prior cardiovascular disease, troponin, D-dimer, and RVSP were related to events at 30 days. Conclusion Bedside Doppler assessment of RVSP appears promising for short-term risk stratification in hospitalized COVID-19 patients 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.