Echocardiographic and Electrocardiographic Findings in COVID-19 Patients: A Cross-Sectional Study

Abstract

Background: There are still many gaps in our knowledge regarding the direct cardiovascular injuries due to COVID-19 infection. In this study, we tried to find out the effect of SARS-CoV-2 infection on cardiac function in patients without any history of structural heart disease by electrocardiographic and echocardiographic evaluations. Methods: This was a cross-sectional study on patients with COVID-19 infection admitted to Imam Reza hospital, Mashhad, Iran between 14 April and 21 September 2020. COVID-19 infection was verified by a positive reverse-transcriptase polymerase chain reaction (PCR) assay for SARS-CoV-2 using nasopharyngeal/oropharyngeal samples. We enrolled all patients over 18 years old with definite diagnosis of COVID-19 infection. At admission, demographic data, comorbid conditions, physical examination, Lung CT scan and laboratory findings were recorded. All patients underwent a comprehensive transthoracic echocardiography at the first week of admission. Clinical and imaging data were collected prospectively. Findings: In total, 142 patients were enrolled in this study. The mean age of participants was 60.69± 15.70 years (range: 30-90 years). Most patients were male (82, 57.7%). The most common findings were left axis deviation (15.5%) in ECG and Right ventricle (RV) dysfunction (34.5%) in echocardiography. Multivariate analysis showed that O2 saturation at admission was independently a predictor of re-hospitalization (P<0.001). Moreover, pulmonary artery systolic pressure (PASP) (P=0.026), RV enlargement (P=0.037) and also dyslipidemia (P=0.002) were significant predictors of in-hospital mortality after adjusting the analysis for potential cofounders. RV size (P<0.001), dyslipidemia (P<0.001), ejection fraction (EF) (P<0.001), age (P=0.020), systolic blood pressure (P=0.001), O2 saturation (P=0.018) and diabetes (P=0.025) independently predicted 30-days mortality. Interpretation: Echocardiography can be used for risk assessment in patients with COVID-19, especially in those with previous history of diabetes and dyslipidemia. The infection could result in Ventricular dysfunction, even in those without previous history of structural heart disease. Funding Statement: There is no funding. Declaration of Interests: Authors declared no conflict of interest. Ethics Approval Statement: Mashhad University of Medical Sciences was the approved the study design and its ethical committee approved the study.