Discussion:
To our knowledge, this is the largest study to evaluate the
cardiovascular prevalence, biomarkers, and echocardiographic features in
patients with severe COVID-19 infection. The main findings of the study
can be summarized as follows: a large proportion of patients with severe
COVID-19 infection have echocardiographic abnormalities including right
and left ventricular dysfunction. The presence of these abnormalities is
strongly associated with underlying clinical and biochemical severity of
COVID-19 illness. Several of these clinical and biochemical variables
are powerful predictors of mortality and can be used as effective tools
to refine risk stratification and filters for further clinical testing
including echocardiography.
Coronavirus disease 2019 (COVID-19), the novel infection caused by the
severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first
detected in China in December, 2019 and declared a global pandemic by
the World Health Organization in early 2020 (7). It has posed a
significant health care threat in the United States where, as of May 22,
2020, over 1.5 million people have been infected resulting in over
90,000 deaths (8). Early reports from China demonstrated that a
significant majority of patients had mild symptoms (no pneumonia or mild
pneumonia) but patients with co-morbid conditions, such as
cardiovascular disease and cardiovascular risk factors (diabetes and
hypertension), have more severe clinical course and higher case fatality
rates (9). Severe pneumonia resulting in acute respiratory distress
syndrome (ARDS) and acute respiratory failure remain the main causes of
mortality in critically ill patients with COVID-19 (10). Furthermore,
recent studies have identified the interplay of coagulation activation
and sustained inflammatory response as an important factor contributing
to increased complications and poorer outcomes in COVID-19 patients.
These include the development of ARDS, multi organ failure including
acute kidney injury, disseminated intravascular coagulation, clinically
significant pulmonary embolism (PE), deep vein thrombosis (DVT) and an
exaggerated inflammatory activation with hypercytokinaemia (3,4,7).