Determining which hospitalized COVID-19 patients require an urgent echocardiogram

Yuan, Neal; Wu, Stephanie; Rader, Florian; Siegel, Robert J.

Background Patients hospitalized with COVID-19 infection often have abnormal transthoracic echocardiogram (TTE) findings. However, while not all TTE abnormalities result in changes in clinical management, performing TTEs in recently infected patients increases disease transmission risks. It remains unknown whether common biomarker tests, such as troponin and B-type natriuretic peptide (BNP), can help distinguish in which COVID-19 patients a TTE may be safely delayed until infection risks subside. Method Using electronic health records data and chart review, we retrospectively studied all patients hospitalized with COVID-19 infection at our multi-site healthcare system from 2/27/2020-1/15/2021 who underwent a TTE within 14 days of their first positive COVID-19 test and had a BNP and troponin measured before or within 7 days of TTE. The primary outcome was presence of ≥1 urgent echocardiographic finding defined as left ventricular ejection fraction ≤35%, wall motion score index ≥1.5, ≥moderate right ventricular dysfunction, ≥moderate pericardial effusion, intracardiac thrombus, pulmonary artery systolic pressure >50mmHg, or ≥moderate-severe valvular disease. We conducted stepwise logistic regression to determine biomarkers and comorbidities associated with the outcome. We evaluated the performance of a rule for classifying TTEs using troponin and BNP. Results We included 434 hospitalized and 151 ICU COVID-19 patients. Urgent TTE findings were present in 105 (24.2%) patients. Troponin and BNP were abnormal in 311 (71.7%). Heart failure (OR (95%CI) 5.41 (2.61-11.68)), troponin >0.04ng/mL (4.40 (2.05-10.05)), BNP >100pg/mL (5.85 (2.35-16.09)) remained significant predictors of urgent TTE findings after stepwise selection. 95.1% of all patients and 91.3% of ICU patients with normal troponin and BNP had no urgent TTE findings. Conclusions Troponin and BNP were highly associated with urgent echocardiographic findings and may be used in triaging algorithms for determining which patients may safely delay their TTE studies until after their peak infectious window has passed.