Global evaluation of echocardiography in patients with COVID-19. (18th June 2020)

• Record Type: Journal Article
• Authors: Dweck, Marc R; Bularga, Anda; Hahn, Rebecca T; Bing, Rong; Lee, Kuan Ken; Chapman, Andrew R; White, Audrey; Salvo, Giovanni Di; Sade, Leyla Elif; Pearce, Keith; Newby, David E; Popescu, Bogdan A; Donal, Erwan; Cosyns, Bernard; Edvardsen, Thor; Mills, Nicholas L; Haugaa, Kristina
• Is Part Of: European heart journal. Volume 21:Number 9(2020)
• Page Start: 949
• Page End: 958
• Publication Date: 2020-06-18
• Subjects: COVID-19 -- Echocardiography; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa178
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography. Methods and results: In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities. A total of 1216 patients [62 (52–71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease ( n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease. Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75–5.05) and cardiac troponin (OR 1.69, 95% CI 1.13–2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73–6.10) for the latter. Echocardiography changed management in 33% of patients. Conclusion: In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.