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This prospective international survey examined echocardiographic abnormalities in 1216 patients with presumed or confirmed COVID-19. Over half of patients (55%) had at least one abnormality detected on an echocardiogram. Both left and right ventricular abnormalities were common (detected in 39% and 33% of patients, respectively). In 15% of patients, there was evidence of severe cardiac disease. Abnormalities were common, even in patients who did not have pre-existing cardiac disease, of whom 46% had an abnormal echocardiogram.
Despite the challenges associated with performing echocardiography on patients with COVID-19, this study suggests that it may be important for some patients because echocardiographic abnormalities in patients with COVID-19 are often severe and were common in patients without a prior history of cardiac disease. While limited by its observational nature, the study also provides information that may be helpful in identifying which patients are most likely to benefit from echocardiography to improve patient selection.
This abstract is available on the publisher's site.
To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography.
METHODS AND RESULTS
In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities. A total of 1216 patients [62 (52-71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease (n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease. Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75-5.05) and cardiac troponin (OR 1.69, 95% CI 1.13-2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73-6.10) for the latter. Echocardiography changed management in 33% of patients.
In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.
Global Evaluation of Echocardiography in Patients With COVID-19
Eur Heart J Cardiovasc Imaging 2020 Jun 18;[EPub Ahead of Print], MR Dweck, A Bularga, RT Hahn, R Bing, KK Lee, AR Chapman, A White, GD Salvo, LE Sade, K Pearce, DE Newby, BA Popescu, E Donal, B Cosyns, T Edvardsen, NL Mills, K Haugaa