S'abonner

Determining Which Hospitalized Coronavirus Disease 2019 Patients Require Urgent Echocardiography - 03/08/21

Doi : 10.1016/j.echo.2021.03.010 
Neal Yuan, MD , Stephanie Wu, MD, Florian Rader, MD, Robert J. Siegel, MD
 Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 

Reprint requests: Neal Yuan, MD, 8700 Beverly Boulevard, Davis 1015, Los Angeles, CA 90048.8700 Beverly BoulevardDavis 1015Los AngelesCA90048

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Abstract

Background

Patients hospitalized with coronavirus disease 2019 (COVID-19) often have abnormal findings on transthoracic echocardiography (TTE). However, although not all abnormalities on TTE result in changes in clinical management, performing TTE in recently infected patients increases disease transmission risks. It remains unknown whether common biomarker tests, such as troponin and B-type natriuretic peptide (BNP), can help distinguish in which patients with COVID-19 TTE may be safely delayed until infection risks subside.

Methods

Using electronic health records data and chart review, the authors retrospectively studied all patients hospitalized with COVID-19 in a multisite health care system from March 1, 2020, to January 15, 2021, who underwent TTE within 14 days of their first positive COVID-19 result and had BNP and troponin measured before or within 7 days of TTE. The primary outcome was the presence of one or more urgent echocardiographic findings, defined as left ventricular ejection fraction ≤ 35%, wall motion score index ≥ 1.5, moderate or greater right ventricular dysfunction, moderate or greater pericardial effusion, intracardiac thrombus, pulmonary artery systolic pressure > 50 mm Hg, or at least moderate to severe valvular disease. Stepwise logistic regression was conducted to determine biomarkers and comorbidities associated with the outcome. The performance of a rule for classifying TTE using troponin and BNP was evaluated.

Results

Four hundred thirty-four hospitalized and 151 intensive care unit patients with COVID-19 were included. Urgent findings on TTE were present in 105 patients (24.2%). Troponin and BNP were abnormal in 311 (71.7%). Heart failure (odds ratio, 5.41; 95% CI, 2.61–11.68), troponin > 0.04 ng/mL (odds ratio, 4.40; 95% CI, 2.05–10.05), and BNP > 100 pg/mL (odds ratio, 5.85; 95% CI, 2.35–16.09) remained significant predictors of urgent findings on TTE after stepwise selection. No urgent findings on TTE were seen in 95.1% of all patients and in 91.3% of intensive care unit patients with normal troponin and BNP.

Conclusions

Troponin and BNP were highly associated with urgent echocardiographic findings and may be used in triaging algorithms for determining in which patients TTE can be safely delayed until after their peak infectious window has passed.

Le texte complet de cet article est disponible en PDF.

Highlights

Most COVID-19 patients with normal troponin and BNP had no urgent TTE findings.
Troponin and BNP may help determine which patients can safely delay TTE.

Le texte complet de cet article est disponible en PDF.

Keywords : Transthoracic echocardiography, Safety, Risk stratification, COVID-19, Troponin, B-type natriuretic peptide

Abbreviations : BNP, COVID-19, ICU, LV, TTE


Plan


 Dr. Yuan was supported by the National Heart, Lung, and Blood Institute (grant T32 5T32HL116273-07). The funding organizations had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
 Conflicts of interest: None.


© 2021  American Society of Echocardiography. Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 34 - N° 8

P. 831-838 - août 2021 Retour au numéro
Article précédent Article précédent
  • Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study
  • Ilya Karagodin, Cristiane Carvalho Singulane, Gary M. Woodward, Mingxing Xie, Edwin S. Tucay, Ana C. Tude Rodrigues, Zuilma Y. Vasquez-Ortiz, Azin Alizadehasl, Mark J. Monaghan, Bayardo A. Ordonez Salazar, Laurie Soulat-Dufour, Atoosa Mostafavi, Antonella Moreo, Rodolfo Citro, Akhil Narang, Chun Wu, Tine Descamps, Karima Addetia, Roberto M. Lang, Federico M. Asch, WASE-COVID Investigators, Vince Ryan V. Munoz, Rafael Porto De Marchi, Sergio M. Alday-Ramirez, Consuelo Orihuela, Anita Sadeghpour, Jonathan Breeze, Amy Hoare, Carlos Ixcanparij Rosales, Ariel Cohen, Martina Milani, Ilaria Trolese, Oriana Belli, Benedetta De Chiara, Michele Bellino, Giuseppe Iuliano
| Article suivant Article suivant
  • Novel Echocardiographic Algorithm for Right Ventricular Mass Quantification: Cardiovascular Magnetic Resonance and Clinical Prognosis Validation
  • Jonathan Kochav, Jennifer Chen, Lakshmi Nambiar, Hannah W. Mitlak, Arielle Kushman, Razia Sultana, Evelyn Horn, Arindam RoyChoudhury, Richard B. Devereux, Jonathan W. Weinsaft, Jiwon Kim

Bienvenue sur EM-consulte, la référence des professionnels de santé.

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.