key: cord-305650-su6furzi
authors: Sud, Karan; Vogel, Birgit; Bohra, Chandrashekar; Garg, Vaani; Talebi, Soheila; Lerakis, Stamatios; Narula, Jagat; Argulian, Edgar
title: Echocardiographic Findings in COVID-19 Patients with Significant Myocardial Injury
date: 2020-06-05
journal: J Am Soc Echocardiogr
DOI: 10.1016/j.echo.2020.05.030
sha: 
doc_id: 305650
cord_uid: su6furzi

nan

Myocardial injury has been commonly described in COVID-19 patients, and has been suggested to have prognostic significance.(1) Multiple possible mechanisms have been suggested. (2, 3) Echocardiography allows non-invasive assessment of biventricular function, and can provide important insights into the possible mechanisms. (4) We aimed at describing echocardiographic findings in hospitalized COVID-19 patients with significant myocardial injury.

In this retrospective study, we enrolled consecutive hospitalized patients with COVID-19 infection who underwent clinically-indicated transthoracic echocardiograms at Mount Sinai Morningside Hospital, New York, NY.(5) Echocardiograms were performed following a timeefficient protocol with appropriate protective gear. Portable ultrasound machines were used: CX50, Philips and VividS70, General Electric. Echocardiographic studies were interpreted by experienced, board-certified echocardiography attending physicians. Significant myocardial injury was defined as a peak cardiac troponin I level exceeding 1 ng/ml (reference <0.01 ng/ml).

Continuous variables are presented as mean or median and categorical variables as proportions.

A total of 24 patients with significant myocardial injury were identified among 110 patients who underwent echocardiography (5 excluded due to poor study quality). The mean age was 64.5 (standard deviation 13.8) years, and 11 (46%) patients were female. Ten (42%) patients were mechanically ventilated at the time of echocardiography. Five (21%) patients had known history of coronary artery disease. The median troponin level was 5.0 (interquartile range-(IQR) 1.8-14.0) ng/ml. Among these 24 patients, 3 patients had EKG findings consistent with ST-elevation myocardial infarction (STEMI) and 1 patient had diffuse-STE consistent with pericarditis. The remaining did not have any distinct clinical/ EKG characteristic to suggest the underlying mechanism of injury. Left ventricular (LV) dysfunction defined as regional and/or global systolic dysfunction was present in 13 (54%) patients. Eleven (46%) had regional wall motion abnormalities (median troponin level 12.4 ng/ml, IQR 5.8-27.0): 3 confirming afore-mentioned STEMI, 2 with pre-existing wall motion abnormalities and 6 with a presumed new abnormality (3 out of these 6 had previous echocardiograms with preserved LV function). Among patients with new wall motion abnormalities, wall motion pattern was confined to a single coronary territory in 4 patients, more than single territory in 1 patient, and 1 patient had a typical wall This is a small, retrospective, single center study. The population was selected from the total number of COVID-19 patients admitted to our hospital during this time period. Confirmatory testing including advanced cardiac imaging/ coronary angiography was lacking in most patients.

In conclusion, among hospitalized patients with COVID-19 and significant myocardial injury, 37% had isolated LV dysfunction, 17% had isolated right ventricular dysfunction, 17% had biventricular dysfunction, and remaining 29% had preserved biventricular function. Regional LV dysfunction appears to be the most common echocardiographic finding, which suggests that ischemia due to large or small vessel obstruction and prothrombotic state may be a common mechanism of injury.

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China

Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease

Echocardiographic Features of COVID-19 Illness and Association with Cardiac Biomarkers

Right Ventricular Dilation in Hospitalized Patients with COVID-19 Infection