Limitations
This is a relatively small, single-center study on consecutive patients hospitalized with severe COVID-19. This limits the generalizability of the findings discussed. Echocardiograms were ordered at the discretion of treating physicians and represent roughly 15% of patients treated at our center, most of whom already had unfavorable clinical course at the time of the study. This accounts in part for the higher mortality (31%) seen in our cohort compared to the previous Wuhan echocardiogram report (6) which reported a 15% mortality in their imaged patients. Given ongoing efforts to limit the spread of COVID-19, routine echocardiograms that are unlikely to change patient management were minimized. When performed, echocardiographic studies were limited to features deemed most clinically relevant: LV size and function, RV size and function, significant valvular abnormalities, and presence of pericardial effusions. Measurements of ventricular strain and LV diastolic function were not obtained. Nonetheless, this experience represents the largest and most comprehensive report on echocardiogram features and biochemical cardiac markers in COVID 19 patients thus far.