Transthoracic echocardiographic analysis of moderate to severe COVID-19 patients admitted to ICU at tertiary hospital in India
Keywords:COVID-19, Trans-thoracic echo, LV dysfunction, RV dysfunction
Background: To describe the transthoracic echocardiographic findings of moderate to severe COVID-19 patients admitted to ICU.
Methods: We studied the transthoracic echocardiographic findings performed within 48 hours on admission to ICU of 426 moderate to severe COVID-19 patients from July 2020 to September 2020 during their course of treatment. Echocardiographic study included left ventricular (LV) systolic and diastolic function, left ventricle wall motion abnormalities and right ventricular (RV) assessment.
Results: The median age of patients was 58.2 (range 19 to 92 years) and majority of patients were male (71%). Pre-existing comorbidities were reported in 95.5% of patient’s, majority being hypertension (42.7%) and diabetes mellitus (39.2%). Abnormal echo findings were noted in 40.8% (n=174) with majority of abnormal findings noted in age group of 60-69 (n=54), men (n=114) and in patients with pre-existing coronary artery disease (CAD) (n=28). The common pattern of cardiac abnormalities was LV systolic dysfunction (n=73, 17.1%), RV dysfunction (n=30, 7%) and abnormal PA pressures (n=144, 85.2%). Abnormal echo findings were noted in 46% of patients who died and 33.9% of patients who required hospital stay of more than 10 days.
Conclusions: Forty percent of admitted patients to ICU had abnormal echocardiography findings with around eighty five percent of them having raised pulmonary artery pressures. Trans-thoracic echocardiography could be used as a prognostication tool of patients admitted to COVID ICU.
Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17(5):259-60.
Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. 2020; 5(7):831-40.
Kang Y, Chen T. Cardiovascular manifestations and treatment considerations in Covid-19. Heart. 2020;106(15):1132-41.
Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J. 2020;41(19): 1821-9.
Shi S, Qin M, Cai Y, Liu T, Shen B, Yang F, et al. Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019. Eur Heart J. 2020;41(22):2070-9.
Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-10.
Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with Coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-8.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
Bavishi C, Bonow RO, Trivedi V, Abbott JD, Messerli FH, Bhatt DL. Acute myocardial injury in patients hospitalized with COVID-19 infection: a review. Prog Cardiovasc Dis. 2020.
Pirzada A, Mokhtar AT, Moeller AD. COVID-19 and myocarditis: what do we know so far? CJC. 2020;2:278-85.
Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17(9):543-58.
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395:1417-8.
Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020;141:2113-6.
Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, et al. ST-segment elevation in patients with Covid-19 - a case series. N Engl J Med. 2020;382:2478-80.
Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, et al. Suspected myocardial injury in patients with COVID-19: Evidence. Nat Rev Cardiol. 2020;17(8):413-8.
Carrizales-Sepúlveda EF, Vera-Pineda R, Flores-Ramírez R, Hernández-Guajardo DA, Pérez-Contreras E, Lozano-Ibarra MM, Ordaz-Farías A. Echocardiographic Manifestations in COVID-19: A Review. Heart Lung Circ. 2021;30(8):1117-29.
Dweck MR, Bularga A, Hahn RT, Bing R, Lee KK, Chapman AR, et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging. 2020;21(9):949-58.
Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. Spectrum of Cardiac Manifestations in COVID-19 - a Systematic Echocardiographic Study. Circulation. 2020;142(4):342-53.
Jain SS, Liu Q, Raikhelkar J, Fried J, Elias P, Poterucha TJ, et al. Indications for and findings on transthoracic echocardiogram in COVID-19. J Am Soc Echocardio. 2020;33(10):1278-84.
ahmoud-Elsayed HM, Moody WE, Bradlow WM, Khan-Kheil AM, Senior J, Hudsmith LE, et al. Echocardiographic findings in patients with COVID-19 pneumonia. Can J Cardiol. 2020;36(8):1203-7.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1-9.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American college of cardiology foundation/american heart association task force on practice guidelines. Circulation. 2013;128:1810-52.
American College of Cardiology. Heart failure, 2017. Available at: https://www.acc.org/tools-and-practice-support/clinicaltoolkits/heartfailurepractice assessment-outpatient-setting. Accessed on 20 November 2021.