Prevalence of echocardiographic abnormalities in patients hospitalised with COVID-19

Chong, D.; Seyala, I.; Hamza, M.; Shah, S.; Makhlouf, K.; Wong, W. C.; Bridgwood, G.; Griffith, B.; Maseda, D.

Introduction COVID-19 is a multi-systemic disease and cardiac involvement has been widely recognised. Impaired cardiac function is linked to worse prognosis and has important implications on patient management. Evidence-based recommendations to guide selection of COVID-19 patients for transthoracic echocardiogram (TTE) are lacking, and there are concerns regarding unnecessary exposure of sonographers to infection risks. Purpose 1. To determine the prevalence and nature of abnormal TTE findings in patients who underwent TTE within 6 months of admission to our centre with COVID-19 infection. 2. To determine if specific clinical characteristics were predictors of an abnormal TTE finding. Methods A retrospective cohort study of all patients admitted to a single hospital with confirmed COVID-19 (through PCR) from 27/03/2020 to 21/06/2020, cross matched with the local TTE database.Data on patient demographics, TTE indication, biochemical markers, selected co-morbidities, ITU admission and mortality were collected. Patients with abnormal TTE were defined by the presence of left ventricular systolic dysfunction (LVSD), right ventricular systolic dysfunction (RVSD), regional wall motion abnormalities (RWMA) or pericardial effusion. Where available, patients with abnormal TTE were compared to previous TTE results to determine if findings were new. If LVSD was previously present, any worsening in category of severity was considered significant. Unpaired t test and Fisher's exact test were used for between group statistical analysis. Results We identified 71 (12%) patients who underwent TTE from 597 patients admitted with a diagnosis of COVID-19. The mean age was 71 (42-93) years and 37 (52%) were male. 18 (25%) patients died within the admission and 15 (21%) required ITU care. The most frequent indications for TTE were suspected heart failure (42%), endocarditis (17%), MI (13%), valvular dysfunction (7%) and myopericarditis/effusion (7%).A total of 33 (46%) patients had an abnormal TTE. Of these, 30 (91%) were new findings. LVSD was detected in 26 (37%) cases: 5 (7%) mild, 8 (11%) moderate and 12 (17%) severe. RVSD was detected in 12 (17%), pericardial effusion in 9 (13%) and RWMA in 10 (14%).The only clinical characteristic that predicted an abnormal TTE was raised high sensitivity troponin (table 1). There was a trend towards an abnormal TTE in patients with known ischaemic heart disease (30% Vs 13%, p = 0.09). Increased mortality was observed in the abnormal TTE group (34% Vs 18%) although this did not reach statistical significance. Conclusions There was a high prevalence of significant TTE abnormalities in patients admitted to our hospital with COVID-19 where TTE was clinically indicated. Our cohort had a predominance for LVSD rather than RVSD compared to other studies. Raised high sensitivity troponin level was a predictor of an abnormal TTE and may guide selection of COVID-19 patients for TTE.