Prevalence of cardiac pathology and relation to mortality in a multiethnic population hospitalised with COVID-19

OBJECTIVE

To determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19.

METHODS

A retrospective and prospective observational study of inpatients referred for transthoracic echocardiography for suspected cardiac pathology due to COVID-19 within a London NHS Trust. Echocardiograms were performed to assess left ventricular (LV), right ventricular (RV) and pulmonary variables along with collection of patient demographics, comorbid conditions, blood biomarkers and outcomes.

RESULT

In the predominant non-white (72%) population, RV dysfunction was the primary cardiac abnormality noted in 50% of patients, with RV fractional area change <35% being the most common marker of this RV dysfunction. By comparison, LV systolic dysfunction occurred in 18% of patients. RV dysfunction was associated with LV systolic dysfunction and the presence of a D-shaped LV throughout the cardiac cycle (marker of significant pulmonary artery hypertension). LV systolic dysfunction (p=0.002, HR 3.82, 95% CI 1.624 to 8.982), pulmonary valve acceleration time (p=0.024, HR 0.98, 95% CI 0.964 to 0.997)-marker of increased pulmonary vascular resistance, age (p=0.047, HR 1.027, 95% CI 1.000 to 1.055) and an episode of tachycardia measured from admission to time of echo (p=0.004, HR 6.183, 95% CI 1.772 to 21.575) were independently associated with mortality.

CONCLUSIONS

In this predominantly non-white population hospitalised with COVID-19, the most common cardiac pathology was RV dysfunction which is associated with both LV systolic dysfunction and elevated pulmonary artery pressure. The latter two, not RV dysfunction, were associated with mortality.

Contrast echocardiography facilitates appropriate management of hospitalized patients with coronavirus disease 2019 (COVID-19) and suspected right ventricular masses: case series

Background

Coronavirus disease 2019 (COVID-19) infection is associated with a coagulopathy with high incidence of venous thrombo-embolism. However, bleeding risk is also significant, causing difficulty in initiating and adjusting anticoagulation therapy in case of suspected thrombi. Cardiac masses can be challenging to be identified properly in the context of this disease. The use of bedside contrast echocardiography (CE) can be of a great value in this situation decreasing procedure-related risk and allowing proper diagnosis and management of a cardiac mass.

Cases summary

We present two cases who were admitted with severe COVID-19 infection. Both cases had additional risk factors for hypercoagulability. Un-enhanced echocardiography was performed and revealed right ventricular (RV) dysfunction with a suspected RV mass. The use of bedside CE could confirm a RV thrombus in the first case and exclude it in the second case. Hence, anticoagulation therapy could be adjusted accordingly in both patients.

Discussion

Coronavirus disease 2019 infection is associated with peripheral thrombo-embolism and cardiac thrombi. Given the critical condition of many patients affected by COVID-19, imaging for thrombo-embolic events is often restricted. With the use of bedside CE, cardiac masses may be correctly identified, aiding proper adjustment of anticoagulation therapy.

Feasibility, efficacy and safety of exercise stress echocardiography during the COVID-19 pandemic

OBJECTIVE

To assess the feasibility, efficacy and safety of performing exercise stress echocardiography (ESE) for the assessment of myocardial ischaemia during the COVID-19 pandemic.

METHODS AND RESULTS

Baseline data were collected prospectively on 740 consecutive patients (mean age 61.4 years, 56.8% males), referred for a stress echocardiogram (SE), who underwent ESE between July 2020 (immediate post lockdown) and January 2021 according to national safety guidelines, in addition to patients wearing masks during ESE. Retrospective analysis was performed on follow-up data for outcomes. Propensity score matching was used to compare workload achieved during ESE pre-COVID-19, in 768 consecutive patients who underwent ESE between May 2014 and May 2015. Of the 725 (97.9%) diagnostic tests obtained, 69 (9.3%) demonstrated significant inducible ischaemia (≥3 segments) with no serious adverse events. Of the 61 patients who underwent coronary angiography, 51 (83%) demonstrated flow-limiting coronary artery disease. During a mean follow-up period of 4.6 months, one first-cardiac event was recorded.Compliance with mask-wearing throughout ESE was seen in 98.7% of patients. Of the 17 healthcare professionals performing ESE, none contracted COVID-19 during this period. SE service performance increased to 96.8% of prepandemic levels (100%) from 26.6% at the start of July 2020 to the end of December 2020.Propensity-matched data showed no significant difference in exercise workload between patients undergoing ESE during and prepandemic.

CONCLUSION

Performing ESE during the COVID-19 pandemic, with safety measures in place, is feasible, efficacious and safe. It impacted on the time patients were waiting to undergo a diagnostic test and yielded appropriate outcomes.Service evaluation authorisation of research capability numberSE20/059.

Efficacy and safety of use of ultrasound enhancing agent in patients hospitalized with COVID-19

PURPOSE

The efficacy and safety of ultrasound enhancing agent (UEA) was unknown in the COVID-19 hospitalized patients. We set out to establish the utility of UEA and its safety profile.

METHODS

A retrospective observational study of prospectively assessed hospitalized patients referred for transthoracic echocardiography (TTE) for suspected cardiac pathology due to COVID-19. The indications and subsequent ability to answer the indications for all TTE were reviewed, as well as impact on diagnosis and management. UEA safety was considered through 48 h mortality.

RESULTS

From a total of 364 patients (mean age 64.8yrs, 64% males) hospitalized with COVID-19 with TTE requested, an indication could be identified in 363, and 61 required administration of UEA. Standard TTE was able to answer the original indication in 275 (75.8%) patients. This was increased to 322 (88.7%) patients, a relative increase of 17.1%, with the use of UEA (p < 0.001). There was subsequent change in diagnosis in 22 out of 61 (36%) patients receiving UEA and change in management in 13 out of 61 (21.3%). There was no significant increase in 48 h (p = 0.14) mortality with UEA use. The patient population of TTE with UEA versus TTE without UEA differed in having a higher incidence of left ventricular systolic dysfunction, right ventricular dilatation, and self-defined white ethnicity.

CONCLUSION

The use of UEA in COVID-19 hospitalized patients, including those who were critically ill, provided incremental information when compared to TTE without UEA resulting in both changes in diagnosis and management plan and appears to be safe.