Introduction:
COVID-19, caused by SARS-CoV-2, is a global pandemic that is evolving
rapidly. The incidence, prevalence and potential mechanisms of
cardiovascular manifestations in COVID 19 patients remain an area of
active investigation. Patients with cardiovascular disease are more
susceptible to COVID-19 and have a more severe clinical course once
infected (1). However, it is not known if the presence of
cardiovascular disease poses independent risk or whether higher rates of
observed adverse outcomes are confounded by other concomitant factors
such as increased age or comorbid conditions. Multiple studies, mostly
emanating from China, have demonstrated myocardial injury with cardiac
biomarker elevation in 7-28% of patients and an association with
increased risk of mortality (2). COVID-19 infection has also been
associated with other cardiovascular abnormalities including
myocarditis, cardiac arrhythmias and cardiomyopathy (3). Right-sided
heart failure as a result of massive pulmonary embolism (PE) due to
COVID-19 has been documented in several recent reports (4, 5). Right
ventricular (RV) dysfunction has also recently been shown to be a
predictor of mortality (6).
Given the risk of healthcare worker and patient exposure and potential
contamination of equipment, echocardiographic evaluation is not
frequently performed in these patients despite biochemical evidence of
myocardial injury. As such, while there are multiple small individual
reports of cardiac involvement in COVID-19, there has been no
comprehensive evaluation of the potential clinical, biochemical and
echocardiographic correlates in COVID-19 patients thus far.
As a quaternary care hospital in the state of New Jersey, one of the
epicenters of COVID-19 infection in the U.S, we were able to gain unique
insight into the clinical course, cardiovascular manifestations, and
outcomes of patients with severe COVID-19. The purpose of this study was
to evaluate the prevalence of particular cardiovascular abnormalities
identified on transthoracic echocardiography, their association with
baseline cardiovascular risk factors and the potential role of clinical
and laboratory features as predictors of mortality in patients with
severe COVID-19.