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Swollen heart in COVID-19 patients who progress to critical illness: a perspective from echo-cardiologists

Yingxian Liu1, Jinjie Xie2, Peng Gao1

  • 1Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Beijing, 100730, China.

ESC Heart Failure
|September 25, 2020
PubMed

Insights

Critical care echocardiography in COVID-19 patients revealed frequent cardiac abnormalities, including pericardial effusion and reduced cardiac index. A lower cardiac index was the strongest predictor of mortality in the ICU.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Cardiac complications are prevalent in critically ill COVID-19 patients, contributing to mortality.
  • The diagnostic and prognostic value of critical care echocardiography (CCE) in this population remains understudied.

Purpose of the Study:

  • To investigate the role of CCE in assessing cardiac structure and function in critically ill COVID-19 patients.
  • To determine the association between echocardiographic findings and in-intensive care unit (ICU) mortality.

Main Methods:

  • A cohort of 43 ICU patients with COVID-19 underwent bedside CCE.
  • Echocardiographic parameters including pericardial effusion, left ventricular mass index, relative wall thickness, left ventricular stroke volume index (LVSVi), and cardiac index were analyzed.
  • Demographic, clinical, and survival data were collected for multivariate Cox regression and Kaplan-Meier analyses.

Main Results:

  • High frequencies of pericardial effusion (90.7%), increased left ventricular mass index (60.5%), and elevated relative wall thickness (76.7%) were observed.
  • Reduced LVSVi (53.5%) and cardiac index (51.2%) were common.
  • Decreased cardiac index was the strongest predictor of in-ICU death (HR, 0.67; P=0.041). Reduced LVSVi, tricuspid annular plane systolic excursion (TAPSE), and S' were negatively associated with mortality.

Conclusions:

  • Findings suggest COVID-19 may cause a 'swollen heart' with increased ventricular mass and pericardial effusion.
  • Left and right heart dysfunction, indicated by reduced cardiac index and other echocardiographic measures, are associated with increased mortality risk.
  • Clinicians should prioritize assessment of cardiac hemodynamic disorders in critically ill COVID-19 patients.
Abstract

Keywords:
COVID-19Critical patientEchocardiographyMortality

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