Comprehensive Echocardiographic Findings in Critically Ill COVID-19 Patients With or Without Prior Cardiac Disease
Renuka Jain1, Pedro D Salinas2, Stacie Kroboth3
1Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI.
Insights
Echocardiography reveals frequent cardiac complications in intensive care unit (ICU) patients with Coronavirus disease 2019 (COVID-19). Pre-existing heart conditions and findings like right ventricular enlargement worsen outcomes, highlighting echocardiography
Area of Science:
- Cardiology
- Intensive Care Medicine
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) can lead to severe illness requiring intensive care.
- Cardiovascular complications are a significant concern in critically ill COVID-19 patients.
- Echocardiography is essential for assessing cardiac function in the intensive care unit (ICU).
Purpose of the Study:
- To analyze transthoracic echocardiograms in COVID-19 patients admitted to the ICU.
- To identify the prevalence and types of cardiac complications using advanced ultrasound technology.
- To correlate echocardiographic findings with clinical outcomes and patient history.
Main Methods:
- Retrospective analysis of transthoracic echocardiograms from 52 COVID-19 ICU patients.
- Inclusion of experienced sonographers performing focused transthoracic protocols.
- Collection of echocardiographic data, including speckle-tracking, and clinical information from electronic medical records.
Main Results:
- Cardiac complications were identified in 55.7% of patients.
- Right ventricular dysfunction was the most common abnormality.
- Prior cardiac disease, right ventricular enlargement, and pulmonary hypertension were associated with increased morbidity and mortality.
Conclusions:
- Critically ill COVID-19 patients frequently experience cardiac complications.
- Pre-existing cardiac disease exacerbates outcomes in COVID-19 ICU patients.
- Echocardiography is crucial for identifying cardiac issues and guiding management strategies in COVID-19 ICU care.
Purpose:
Coronavirus disease 2019 (COVID-19) presents with a spectrum of disease severity, the most serious cases requiring intensive care. Echocardiography is a front-line tool in evaluating cardiovascular complications of COVID-19 in the intensive care unit (ICU); we analyzed transthoracic echocardiograms obtained from this patient population with state-of-the-art ultrasound technology.
Methods:
All patients with COVID-19 requiring ICU admission on whom a transthoracic echocardiogram was obtained were included in the study. Focused transthoracic protocols were performed by experienced sonographers. Echocardiographic variables, including speckle-tracking echocardiography, were collected and analyzed. Clinical information was obtained from the electronic medical record. Patients were followed until discharge.
Results:
Of 52 total patients (mean age: 59.9 ± 11.6 years), 59.6% were male and 15 (29%) had known prior cardiac disease. Cardiac complications identified on echocardiography were prevalent, occurring in 55.7% of patients. Patients with known prior cardiac disease were more likely to have new or worsening left ventricular dysfunction. Right ventricular dysfunction was the most common abnormality (assessed qualitatively in 18 cases and with advanced echocardiographic methods in 34 cases). Known prior cardiac disease, right ventricular enlargement, and pulmonary hypertension were significantly associated with morbidity and mortality.
Conclusions:
Patients requiring intensive care for COVID-19 face significant morbidity and mortality, and cardiac complications occur in the majority of patients admitted to the ICU with COVID-19. Those with known prior cardiac disease fare worse, and other echocardiographic findings (right ventricular enlargement, pulmonary hypertension) are also associated with worse outcomes. State-of-the-art echocardiography performed by experienced sonographers can be critical to identifying cardiac complications and guiding ICU strategy.
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