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).