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Published on: December 19, 2020
Clinical and echocardiographic findings in patients with COVID-19 across different severity levels
Ihor Hryzhak1, Oleksandra Pryshliak1, Taras Kobryn1
1Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
Insights
Echocardiographic abnormalities like reduced ejection fraction and pulmonary hypertension are linked to severe COVID-19. These cardiac issues, along with chronic heart failure, predict worse outcomes and mortality in COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 can lead to cardiovascular complications.
- Understanding cardiac involvement is crucial for predicting COVID-19 severity and outcomes.
Purpose of the Study:
- To identify echocardiographic abnormalities in COVID-19 patients.
- To determine key prognostic factors for severe and fatal COVID-19 outcomes.
Main Methods:
- Retrospective cohort study of 194 hospitalized COVID-19 patients.
- Analysis of clinical and echocardiogram data.
- Comparison of moderate, severe (favorable outcome), and severe (fatal outcome) groups.
Main Results:
- Severe COVID-19 with favorable outcomes showed reduced left ventricular ejection fraction and diastolic dysfunction compared to moderate cases.
- Fatal COVID-19 cases exhibited significantly decreased left ventricular ejection fraction, myocardial dysfunction, and a trend towards pulmonary hypertension compared to severe cases with favorable outcomes.
- Key cardiac risk factors for severe COVID-19 progression and mortality included chronic heart failure, reduced left ventricular ejection fraction, myocardial dysfunction, and pulmonary hypertension.
Conclusions:
- Echocardiographic findings are vital indicators of COVID-19 severity.
- Chronic heart failure, reduced left ventricular ejection fraction, myocardial dysfunction, and pulmonary hypertension are significant predictors of poor prognosis in COVID-19.
- Targeting these cardiac factors may improve management of severe COVID-19.
Abstract:
Cardiovascular pathology can complicate the course of COVID-19. The study aimed to identify echocardiographic abnormalities and key prognostic factors influencing severe and fatal COVID-19 outcomes. This retrospective cohort study included clinical and echocardiogram data from 194 medical records of hospitalized patients with COVID-19: 100 moderate cases, 34 severe cases with favorable outcomes, and 60 severe cases with fatal outcomes. Severe patients with favorable outcomes had greater reductions in left ventricular systolic fraction of left ventricle compared to moderate cases (23.5% vs. 7.0%, respectively, p=0.008) and ejection fraction of left ventricle (14.7% vs. 3.0%, respectively, p=0.013), grade I diastolic dysfunction of the left ventricle (20.6% vs. 8.0%, respectively, p=0.044), and pulmonary hypertension (29.41% vs. 10.0%, respectively, p=0.006). Patients with fatal outcomes had a mean age of 67.1±1.51 years, chronic heart failure functional class II (58.3%), hypertension (50.0%), type 2 diabetes (43.3%), and obesity (33.3%). Compared to severe cases but with favorable outcomes, fatal cases had a greater decrease in left ventricular ejection fraction (36.7% vs. 14.7%, respectively, p=0.024), various types of myocardial dysfunction (51.7% vs. 29.4%, respectively, p=0.037) and a trend towards increased pulmonary hypertension (48.3% vs. 29.4%, respectively, p=0.074). Consequently, chronic heart failure class II, reduced left ventricular ejection fraction, various myocardial dysfunctions, and pulmonary hypertension emerged as key cardiac risk factors for severe disease progression and mortality in patients with COVID-19.
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