Abstract
BackgroundCOVID-19 pandemic is associated with high morbidity and mortality. Cardiovascular insult is a leading cause of in-hospital mortality in COVID-19 patients, especially right ventricular (RV) dysfunction and massive pulmonary embolism. This study aims to assess short-term impact of COVID 19 infection on (RV) functions among hospitalized patients with moderate or severe illness using bed side trans-thoracic echocardiogram. This study was conducted in 3 isolation hospitals in Cairo, spanning over 3 months during the expected pandemic peak in Egypt in 2020. The study recruited 100 consecutive patients with moderate or severe COVID-19 infection. Four patients refused to participate in the study. Patients with pre-existing structural heart diseases were excluded. All patients underwent full history taking and clinical examination. Bed side echocardiography was done emphasizing on (RV), and (RA) dimensions, (LV) functions and pulmonary artery systolic pressure (PSAS). Cardiac biomarkers were withdrawn and CT angiography was ordered when clinically warranted.ResultsThe mean age of the studied cohort was 59.5 ± 8.6 years with males comprising 71.9% of the studied group. (RV) and (RA) dilatation was noted in 8 cases (8.3%). (LV) dysfunction was noted in 11 cases (11.4%). (PASP) showed a statistically significant negative correlation with (LV) function. However, (PSAP) was positively correlated to (RA) and (RV) dimensions, tricuspid regurgitation (TR) jet severity, previous COVID infection and elevated cardiac biomarkers. Mortality was noted in 3 cases (3.1%), all had LV dysfunction with elevated troponin level. Six patients (6.2%) had combined (LV) and (RV) dysfunction.ConclusionsCOVID-19 illness had a negative impact on (RV) and (LV) functions, that could be assessed accurately by trans-thoracic 2 D echocardiogram. The degree of ventricular dysfunction correlated with the rise in cardiac biomarkers as well as the degree of (PASP).
Highlights
COVID-19 pandemic is associated with high morbidity and mortality
A report from Wuhan, China, reported that 12% of 41 patients hospitalized with COVID-19, had signs of cardiovascular involvement as diagnosed by elevated troponin associated with ECG and echocardiographic
The echocardiogram probe was cleaned using hydrogen peroxide disposable wipes. It is worth-mentioning that once echocardiogram was used in COVID-19 isolation zone, it remained in service in this zone and not allowed to be shared by other departments
Summary
COVID-19 pandemic is associated with high morbidity and mortality. Cardiovascular insult is a leading cause of in-hospital mortality in COVID-19 patients, especially right ventricular (RV) dysfunction and massive pulmonary embolism. This study aims to assess short-term impact of COVID 19 infection on (RV) functions among hospitalized patients with moderate or severe illness using bed side trans-thoracic echocardiogram. A report from Wuhan, China, reported that 12% of 41 patients hospitalized with COVID-19, had signs of cardiovascular involvement as diagnosed by elevated troponin associated with ECG and echocardiographic. Provided the clinical relevance of right ventricular involvement in acute respiratory illness and ARDS, 2D trans-thoracic echocardiogram is recommended to evaluate right heart functions among COVID-19 illness as stated by the American society of echocardiography and European Association of cardiovascular imaging (EACVI) [10,11,12,13,14]. Two dimensional echocardiogram provides simple, fast and reliable bed side test to assess cardiac functions and COVID-19 related cardiovascular complications in patients with hemodynamic instability. For issues concerning infection control, routine bed side echo is not recommended for every admitted patient with COVID19 [15]
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