Indications for and Findings on Transthoracic Echocardiography in COVID-19 - 30/09/20
Abstract |
Background |
Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease.
Methods |
A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE 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%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 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 left ventricular ejection fraction (ρ = −0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation.
Conclusions |
This study describes the clinical indications for use and diagnostic performance of TTE, 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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | TTE is performed in a minority of patients with COVID-19. |
• | Focused studies could be performed quickly, and the majority were diagnostic. |
• | Patients with elevated cardiac biomarkers more often had reduced LV function. |
• | In appropriately selected patients, TTE can guide COVID-19 clinical management. |
Keywords : COVID-19, Echocardiography
Abbreviations : ASE, COVID-19, EACVI, hs-cTnT, LV, LVEF, NT-proBNP, RV, SARS-CoV-2, TR, TTE
Plan
Dr. Clerkin receives support through National Institutes of Health (NIH) grant K23 HL148528. Dr. Abdalla receives support through grant 18AMFDP34380732 from the American Heart Association and from the NIH/National Heart, Lung, and Blood Institute (grants K23 HL141682-01A1 and R01HL146636-01A1). Dr. Bello receives support through NIH grant K23 HL136853. Dr. Poterucha owns stock in Abbott Laboratories, Abvie, Edwards Lifesciences, and Baxter International. Dr. Hahn has received speaking fees from Baylis Medical, Edwards Lifesciences, and Medtronic; has received consulting fees from Abbott Structural, Edwards Lifesciences, Medtronic, Navigate, and Philips Healthcare; has received nonfinancial support from 3mensio; holds equity in Navigate; and is the chief scientific officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr Kirtane reports Institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting; no speaking/consulting fees were personally received. Personal: Travel Expenses/Meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Drs. Uriel and Anstey contributed equally to this work. |
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Conflicts of Interest: Martin B. Leon is an advisory board participant and receives institutional grants for clinical research from Abbott, Boston Scientific, Edwards, and Medtronic. The other authors reported no actual or potential conflicts of interest. |
Vol 33 - N° 10
P. 1278-1284 - octobre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.