Indications for and Findings on Transthoracic Echocardiography in COVID-19
#MMPMID32782131
Jain SS
; Liu Q
; Raikhelkar J
; Fried J
; Elias P
; Poterucha TJ
; DeFilippis EM
; Rosenblum H
; Wang EY
; Redfors B
; Clerkin K
; Griffin JM
; Wan EY
; Abdalla M
; Bello NA
; Hahn RT
; Shimbo D
; Weiner SD
; Kirtane AJ
; Kodali SK
; Burkhoff D
; Rabbani LE
; Schwartz A
; Leon MB
; Homma S
; Di Tullio MR
; Sayer G
; Uriel N
; Anstey DE
J Am Soc Echocardiogr
2020[Oct]; 33
(10
): 1278-1284
PMID32782131
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BACKGROUND: Despite growing evidence of cardiovascular complications associated
with coronavirus disease 2019 (COVID-19), there are few data regarding the
performance of transthoracic echocardiography (TTE) and the spectrum of
echocardiographic findings in this disease. METHODS: A retrospective analysis was
performed among adult patients admitted to a quaternary care center in New York
City between March 1 and April 3, 2020. Patients were included if they underwent
TTE during the hospitalization after a known positive diagnosis for COVID-19.
Demographic and clinical data were obtained using chart abstraction from the
electronic medical record. RESULTS: Of 749 patients, 72 (9.6%) underwent TTE
following positive results on severe acute respiratory syndrome coronavirus-2
polymerase chain reaction testing. The most common clinical indications for TTE
were concern for a major acute cardiovascular event (45.8%) and hemodynamic
instability (29.2%). Although most patients had preserved biventricular function,
34.7% were found to have left ventricular ejection fractions ? 50%, and 13.9% had
at least moderately reduced right ventricular function. Four patients had wall
motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman
rank correlation, there was an inverse relationship between high-sensitivity
troponin T and left ventricular ejection fraction (? = -0.34, P = .006). Among 20
patients with prior echocardiograms, only two (10%) had new reductions in LVEF of
>10%. Clinical management was changed in eight individuals (24.2%) in whom TTE
was ordered for concern for acute major cardiovascular events and three (14.3%)
in whom TTE was ordered for hemodynamic evaluation. CONCLUSIONS: This study
describes the clinical indications for use and diagnostic performance of TTE, as
well as findings seen on TTE, in hospitalized patients with COVID-19. In
appropriately selected patients, TTE can be an invaluable tool for guiding
COVID-19 clinical management.
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