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Cardiac Abnormalities in COVID-19 and Relationship to Outcome

OBJECTIVE: To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: Retrospective cohort study that included consecutive inpatients with COVID-19 infection who underwent clinically indica...

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Autores principales: Krishna, Hema, Ryu, Alexander J., Scott, Christopher G., Mandale, Deepa R., Naqvi, Tasneem Z., Pellikka, Patricia A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mayo Foundation for Medical Education and Research 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816643/
https://www.ncbi.nlm.nih.gov/pubmed/33714597
http://dx.doi.org/10.1016/j.mayocp.2021.01.006
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author Krishna, Hema
Ryu, Alexander J.
Scott, Christopher G.
Mandale, Deepa R.
Naqvi, Tasneem Z.
Pellikka, Patricia A.
author_facet Krishna, Hema
Ryu, Alexander J.
Scott, Christopher G.
Mandale, Deepa R.
Naqvi, Tasneem Z.
Pellikka, Patricia A.
author_sort Krishna, Hema
collection PubMed
description OBJECTIVE: To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: Retrospective cohort study that included consecutive inpatients with COVID-19 infection who underwent clinically indicated transthoracic echocardiography at 10 sites in the Mayo Clinic Health System between March 10 and August 5, 2020. Echocardiography was performed at bedside by cardiac sonographers according to an abbreviated protocol. Echocardiographic results, demographic characteristics, laboratory findings, and clinical outcomes were analyzed. RESULTS: There were 179 patients, aged 59.8±16.9 years and 111 (62%) men; events within 30 days occurred in 70 (39%) patients, including prolonged hospitalization in 43 (24%) and death in 27 (15%). Echocardiographic abnormalities included left ventricular ejection fraction less than 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) of 35 or greater mm Hg in 44 (44%) of 101 in whom it was measured. Myocardial injury, defined as the presence of significant troponin level elevation accompanied by new ventricular dysfunction or electrocardiographic abnormalities, was present in 13 (7%). Prior echocardiography was available in 36 (20%) patients and pre-existing abnormalities were seen in 28 (78%) of these. In a multivariable age-adjusted model, area under the curve of 0.81, prior cardiovascular disease, troponin level, D-dimer level, and RVSP were related to events at 30 days. CONCLUSION: Bedside Doppler assessment of RVSP appears promising for short-term risk stratification in hospitalized patients with COVID-19 infection undergoing clinically indicated echocardiography. Pre-existing echocardiographic abnormalities were common; caution should be exercised in attributing such abnormalities to the COVID-19 infection in this comorbid patient population.
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spelling pubmed-78166432021-01-21 Cardiac Abnormalities in COVID-19 and Relationship to Outcome Krishna, Hema Ryu, Alexander J. Scott, Christopher G. Mandale, Deepa R. Naqvi, Tasneem Z. Pellikka, Patricia A. Mayo Clin Proc Original Article OBJECTIVE: To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: Retrospective cohort study that included consecutive inpatients with COVID-19 infection who underwent clinically indicated transthoracic echocardiography at 10 sites in the Mayo Clinic Health System between March 10 and August 5, 2020. Echocardiography was performed at bedside by cardiac sonographers according to an abbreviated protocol. Echocardiographic results, demographic characteristics, laboratory findings, and clinical outcomes were analyzed. RESULTS: There were 179 patients, aged 59.8±16.9 years and 111 (62%) men; events within 30 days occurred in 70 (39%) patients, including prolonged hospitalization in 43 (24%) and death in 27 (15%). Echocardiographic abnormalities included left ventricular ejection fraction less than 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) of 35 or greater mm Hg in 44 (44%) of 101 in whom it was measured. Myocardial injury, defined as the presence of significant troponin level elevation accompanied by new ventricular dysfunction or electrocardiographic abnormalities, was present in 13 (7%). Prior echocardiography was available in 36 (20%) patients and pre-existing abnormalities were seen in 28 (78%) of these. In a multivariable age-adjusted model, area under the curve of 0.81, prior cardiovascular disease, troponin level, D-dimer level, and RVSP were related to events at 30 days. CONCLUSION: Bedside Doppler assessment of RVSP appears promising for short-term risk stratification in hospitalized patients with COVID-19 infection undergoing clinically indicated echocardiography. Pre-existing echocardiographic abnormalities were common; caution should be exercised in attributing such abnormalities to the COVID-19 infection in this comorbid patient population. Mayo Foundation for Medical Education and Research 2021-04 2021-01-19 /pmc/articles/PMC7816643/ /pubmed/33714597 http://dx.doi.org/10.1016/j.mayocp.2021.01.006 Text en © 2021 Mayo Foundation for Medical Education and Research. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
Krishna, Hema
Ryu, Alexander J.
Scott, Christopher G.
Mandale, Deepa R.
Naqvi, Tasneem Z.
Pellikka, Patricia A.
Cardiac Abnormalities in COVID-19 and Relationship to Outcome
title Cardiac Abnormalities in COVID-19 and Relationship to Outcome
title_full Cardiac Abnormalities in COVID-19 and Relationship to Outcome
title_fullStr Cardiac Abnormalities in COVID-19 and Relationship to Outcome
title_full_unstemmed Cardiac Abnormalities in COVID-19 and Relationship to Outcome
title_short Cardiac Abnormalities in COVID-19 and Relationship to Outcome
title_sort cardiac abnormalities in covid-19 and relationship to outcome
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816643/
https://www.ncbi.nlm.nih.gov/pubmed/33714597
http://dx.doi.org/10.1016/j.mayocp.2021.01.006
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