Dynamics of echocardiographic parameters in patients with severe COVID-19 during hospitalization

Abstract

BACKGROUND: The severe course of a new coronavirus infection may be associated with cardiovascular damage. Thus, there is a need to search for available methods of cardiac status examination to determine management tactics and immediate prognosis in patients with coronavirus disease 2019 (COVID-19).
 AIM: This study aimed to assess the dynamics of echocardiographic parameters in patients with severe infection during hospitalization.
 MATERIALS AND METHODS: Forty patients hospitalized for COVID-19 were included in the study. All patients underwent echocardiography on admission to the hospital and in dynamics, that is, upon deterioration of the underlying disease. The ultrasound picture of the heart was compared with the severity of parenchymal damage based on computed tomography (CT) and the degree of respiratory failure based on blood oxygen saturation by pulse oximetry. Concomitant nosologies and autopsy findings were also analyzed.
 RESULTS: In dynamics, a significant decrease in left ventricular ejection fraction (LVEF) from 47.0% (40.056.0) to 43.5% (37.049.0; p=0.002) was found in the deceased group, which was not observed in the discharged group. Comparative analysis of this index in the discharged and deceased group in study 2 revealed significantly lower values of LVEF in patients with unfavorable hospital prognosis: 51.0% (44.055.0) and 43.5% (37.049.0), respectively (p=0.049). Furthermore, a significantly higher level of systolic pulmonary artery pressure was observed in the deceased group in study 1: 54.0 (50.059.0) and 60.0 (55.570.0) mmHg, respectively (p=0.02), with increasing differences in dynamics, that is, 65.0 (60.070.0) and 50.0 (46.057.0) mmHg, respectively (p 0.0001). Among the indicators reflecting the state of the right ventricle, right ventricular end-systolic size in study 2 in the deceased group (p=0.062) and more pronounced dilatation by this indicator were noted in the group with unfavorable prognosis compared with the discharged group at re-diagnosis (p=0.071).
 CONCLUSIONS: Dynamic reduction of baseline low LVEF and progression of pulmonary hypertension are the main echocardiographic predictors of hospital mortality in patients with COVID-19. Increased volume of pulmonary parenchyma lesions on CT determines unfavorable hospital prognosis.