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Echocardiography and Multimodality Cardiac Imaging in COVID-19 Patients
Alberto Cresti1, Agata Barchitta2, Andrea Barbieri3
1Department of Cardioneurovascular Diseases, Misericordia Hospital, Italy.
Insights
Point-of-care ultrasound is a crucial first-line tool for assessing cardiac injury in patients with coronavirus disease 2019 (COVID-19). Further cardiac imaging may be needed for guiding treatment decisions in these critically ill patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- The COVID-19 pandemic presents significant challenges to healthcare systems, particularly in diagnosing and managing cardiac complications.
- Myocardial injury affects over 25% of COVID-19 patients, necessitating effective diagnostic and prognostic tools.
- Existing evidence on cardiac imaging in COVID-19 is limited, often based on single-center experiences and expert opinions.
Purpose of the Study:
- To review current knowledge on cardiac imaging in COVID-19 patients.
- To provide recommendations for diagnostic pathways and safety measures for cardiac imagers.
- To highlight the role of echocardiography in assessing myocardial injury.
Main Methods:
- Review of existing literature and expert opinion on cardiac imaging in COVID-19.
- Focus on point-of-care ultrasound (POCUS) as a first-line assessment tool.
- Discussion of recommendations for dedicated imaging pathways and safety protocols.
Main Results:
- Point-of-care ultrasound (POCUS) is recommended as a rapid, bedside tool for initial assessment of the heart, chest, and leg veins in COVID-19 patients.
- A secondary level of cardiac imaging is indicated when results can guide decision-making or are life-saving.
- Specialized scanners and dedicated patient pathways are advised for cardiac imaging in COVID-19.
Conclusions:
- Cardiac imaging plays a vital role in the diagnosis and prognosis of myocardial injury in COVID-19.
- Reorganization of diagnostic pathways is essential to minimize infection spread.
- Expert opinion and evolving knowledge guide current recommendations for cardiac imaging in the context of COVID-19.
Abstract:
The pandemic caused by the new SARS-CoV-2, named coronavirus disease 2019 (COVID-19) disease, has challenged the health-care systems and raised new diagnostic pathways and safety issues for cardiac imagers. Myocardial injury may complicate COVID-19 infection in more than a quarter of patients and due to the wide a range of possible insults, cardiac imaging plays a crucial diagnostic and prognostic role. There is still little evidence regarding the best-imaging pathway and the echocardiographic findings. Most of the data derive from the single centers experiences and case-reports; therefore, our review reflects the recommendations mainly based on expert opinion. Moreover, knowledge is constantly evolving. The health-care system and physicians are called to reorganize the diagnostic pathways to minimize the possibility of spreading the infection. Thus a rapid, bedside, ultrasound assessment of the heart, chest, and leg veins by point-of-care ultrasound seems to be the first-line tool of the fight against the SARS-CoV-2. A second Level of cardiac imaging is appropriate when the result may guide decision-making or may be life-saving. Dedicated scanners should be used and special pathways should be reserved for these patients. The current knowledge on cardiac imaging COVID-19 patients is reviewed.
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