Indications and Findings on Transthoracic Echocardiogram in COVID-19

Jain, Sneha S.; Liu, Qi; Raikhelkar, Jayant; Fried, Justin; Elias, Pierre; Poterucha, Timothy J.; DeFilippis, Ersilia M.; Rosenblum, Hannah; Wang, Elizabeth Y.; Redfors, Bjorn; Clerkin, Kevin; Griffin, Jan M.; Wan, Elaine Y.; Abdalla, Marwah; Bello, Natalie A.; Hahn, Rebecca T.; Shimbo, Daichi; Weiner, Shepard D.; Kirtane, Ajay; Kodali, Susheel K.; Burkhoff, Daniel; Rabbani, LeRoy; Schwartz, Allan; Leon, Martin; Homma, Shunichi; DiTullio, Marco R.; Sayer, Gabriel; Uriel, Nir; Anstey, D. Edmund

ABSTRACT Background Despite growing evidence of cardiovascular complications associated with novel 2019 coronavirus disease (COVID-19), there is little data regarding the performance of transthoracic echocardiography (TTE) and spectrum of echocardiographic findings in this disease. Methods We performed a retrospective analysis of adult patients admitted to a quaternary care center in New York City between March 1st and April 3rd, 2020. Patients were included if they had a TTE performed during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. Results Of 749 patients, 72 (9.6%) had a TTE following a positive SARS-CoV-2 PCR test. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). While most patients had preserved biventricular function, 34.7% were found to have a left ventricular ejection fraction (LVEF) ≤ 50% and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation there was an inverse relationship between high sensitivity Troponin T and LVEF (rho = -0.34, p=0.006). Among 20 patients with prior echocardiograms, only two (10%) patients had a new reduction in LVEF of more than 10%. Clinical management was changed in eight (24.2%) of individuals who had a TTE ordered for concern for acute major cardiovascular event; and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. Conclusions This study describes the clinical indications for usage and diagnostic performance, as well as findings seen on TTE in hospitalized patients with COVID-19. In appropriately selected patients TTE can be an invaluable tool for guiding COVID-19 clinical management.