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.