COVID-19 may impair certain kinds of ventricular function
Patients with COVID-19 had impaired left ventricular diastolic and right ventricular function despite most patients having preserved LV systolic function, researchers found in a study published in Circulation.
“When a patient with COVID-19 deteriorates or has a change in troponin or [brain natriuretic peptide], we should perform an echocardiogram, but not to forget about the RV because in a majority of these patients, it is the source of troponin and the focus of clinical deterioration,” Yan Topilsky, MD, professor of cardiology and director of noninvasive cardiology at Tel Aviv Medical Center, told Healio.
Yishay Szekely, MD, a cardiologist at Tel Aviv Sourasky Medical Center and Tel Aviv University Sackler School of Medicine, and colleagues analyzed data from 100 patients (mean age, 66 years; 63% men) with COVID-19 who were admitted to Tel Aviv Medical Center between March 21 and April 16. All patients underwent an echocardiographic evaluation within 24 hours of hospital admission. The assessment was repeated in patients with clinical deterioration, defined as death or hemodynamic, respiratory or cardiac deterioration.
“Little is known about the cardiac manifestations of COVID-19 because all the data gathered until now were based on laboratory and clinical evaluation or case reports in deteriorating patients,” Topilsky said in an interview.
Measures taken during echocardiographic studies included valve hemodynamics, LV systolic and diastolic function, and RV assessment, in addition to a lung ultrasound.
At baseline, 32% of patients had a normal echocardiogram. The most common patterns observed in echocardiograms included RV dilatation with or without dysfunction (39%), in addition to LV diastolic (16%) and systolic dysfunction (10%).
Twenty percent of patients had troponin levels above the 99th percentile. LV systolic function did not significantly differ in patients with elevated troponin or worse clinical condition vs. those with normal troponin levels or better clinical condition. In addition, patients with elevated troponin or worse clinical condition had worse RV function.
Sequential echocardiograms were performed in 20% of patients as a result of clinical deterioration, which occurred at a median of 3.5 days. Common echocardiographic abnormalities observed in these patients include LV systolic and diastolic deterioration (n = 5), and RV function deterioration (n = 12). In the patients with RV failure, five were diagnosed with femoral vein thrombosis.
“[We need more] follow-up research on the patients that recovered from their illness, to assess the short- and long-term clinical implications of cardiac disease in COVID-19 and to assess for the pathogenesis of RV dysfunction in this disease,” Topilsky told Healio.
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Yan Topilsky, MD, can be reached at firstname.lastname@example.org.