Clinical Course and Cardiac Complications of Hospitalized COVID-19 Patients

Rahman, T.; Woo, A.; Doufle, G.; Thavendiranathan, D.

Purpose We describe the hospitalization course, cardiac complications and echocardiographic findings in a subset of acutely ill hospitalized patients with COVID-19. Methods Patients admitted to a large academic hospital in Ontario, Canada from March-June 2020 with COVID-19 and who had an echocardiogram within 4-weeks of their diagnosis were included in this study. Their demographics, hospitalization details and echocardiographic findings were analyzed. Results 76 patients are included in our study, 83% of whom required ICU. Mean age was 58.9 years (+/-15.7 years). Cardiovascular comorbidities were common: diabetes (35.5%), hypertension (50%), CKD (11.8%), prior CAD (13.2%) or stroke (11.8%). Median length of admission was 25.5 days (IQR 22days). Overall, in-hospital mortality was high at 35.5%, with increased mortality in the ICU vs. non-ICU group (32.9% vs. 15.4%). A large number of patients required invasive support: intubation (77.6%), Extracorporeal life support (23.7%), or renal replacement therapy (19.7%). Cardiac complications included new AF (13.2%), hemodynamically significant VT (3.9%), moderate or more pericardial effusion (2.6%) and acute stroke (9.2%). Echocardiographic analysis demonstrated that 7.9% of patients developed moderate or more LV dysfunction on visual assessment. RV dysfunction was more common (27.6%) with 11.8% being visually classified as moderate or greater in severity. High sensitivity troponin was elevated in 59.2% of patients and was statistically higher in patients experiencing cardiac complications (Chi-Square 0.005). Although not achieving significance, there was a trend towards elevated troponin and development of moderate or greater LV/RV dysfunction (Chi-square 0.30). Conclusion In acute patients hospitalized with COVID-19, there was a high prevalence of cardiovascular co-morbidities. Troponin elevations was common and associated with a significantly increased risk of cardiovascular events and a trend towards moderate or greater ventricular dysfunction.