The added predictive role of echocardiography in patients with mild or moderate Coronavirus Disease 2019. (15th January 2023)

• Record Type: Journal Article
• Authors: Lupu, Lior; Banai, Ariel; Szekely, Yishay; Lichter, Yael; Hochstadt, Aviram; Taieb, Philippe; Sapir, Orly; Granot, Yoav; Merdler, Ilan; Ghantous, Eihab; Borohovitz, Ariel; Sadon, Sapir; Levi, Erez; Laufer-Perl, Michal; Banai, Shmuel; Topilsky, Yan
• Is Part Of: International journal of cardiology. Volume 371(2023)
• Page Start: 492
• Page End: 499
• Publication Date: 2023-01-15
• Subjects: COVID-19 -- Echocardiography -- Risk stratification; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.09.079
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Recently, several therapeutic agents have decreased the progression to critical disease in patients with mild/moderate COVID-19. However, their use is limited to patients with ≥1 clinical risk factor. We aimed to evaluate echocardiographic features that may aid in risk stratification for patients with mild/moderate COVID-19. Methods: 278 consecutive patients with mild/moderate COVID-19 underwent prospective clinical and echocardiographic examination, ≤7 days of symptoms, as part of a predefined protocol. Analysis to identify echocardiographic predictors of outcome was performed. Results: In the multivariable risk model, E/e′, TAPSE, and pulmonary acceleration time (PAT) were associated with the composite outcome ( p = 0.01, 0.005, 0.05, respectively). Stepwise analyses showed that the addition of echocardiography on top of having ≥1 clinical risk factor and even using each parameter separately improved the prediction of outcomes. If patients were re-categorized as high risk only if having both ≥1 clinical and ≥ 1 echocardiography risk parameter (E/e′ > 8, TAPSE<1.8 cm, PAT<90 msec), or even one echo parameter separately, then specificity, positive predictive value, and accuracy improved. If patients were re-classified as high risk if having either ≥1 clinical risk factor or ≥ 1 high-risk echocardiography parameter, all five individuals who were missed by the ≥1 risk factor "rule", were correctly diagnosed as high risk. Similar analyses, including only patients with mild disease, showed that the addition of TAPSE improved the prediction of outcomes. Conclusions: In patients with mild/moderate COVID-19, a very limited echocardiographic exam is sufficient for improved outcome prediction, and may improve resource allocation for new anti-COVID-19 agents. Translational aspect of the work: We show that among patients with mild/moderate COVID-19, several easily obtained echocardiographic findings are strongly correlated with mortality or progression to the need for invasive/non-invasive mechanical ventilation, even when adjusted for the presence or absence of ≥1 clinical risk factor. Furthermore, even a limited echocardiographic exam is sufficient to develop a strategy of risk stratification. We believe that our data have important implications for the clinicians involved in the acute treatment of patients with COVID-19. Highlights: Among patients with mild/moderate COVID-19, several echocardiographic parameters are associated with clinical deteriorationicient to develop a strategy of risk stratification and improve outcome prediction We show that E/e′, PAT, and TAPSE have additive predictive value on top of clinical risk factors A limited echocardiographic exam is sufficient to develop a strategy of risk stratification and improve outcome prediction In patients presenting with mild COVID-19, TAPSE has additive predictive value on top of clinical risk factors