Cardiovascular Test Results Can Identify COVID-19 Patients at Higher Risk of Death During Hospitalization

New research has identified cardiovascular test results that might help to identify patients hospitalized with COVID-19 who face an especially high risk of dying.

In a study of patients hospitalized with COVID-19, researchers from the University of Salerno (Fisciano, Italy) found that transthoracic echocardiography (TTE) might be a useful tool in risk stratification of patients with COVID-19.

A variety of cardiovascular complications among hospitalized patients infected by SARS-CoV-2, including arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism, have been reported. Early recognition of these life-threatening conditions is crucial for the therapeutic success. Due to the wide availability and bedside feasibility, TTE is generally considered the first-line imaging approach for patients with suspected or confirmed cardiac disease, particularly in critical care setting. The role of TTE in risk stratification of patients admitted with COVID-19 has been poorly investigated. Hence, the researchers conducted a multicentre study to evaluate clinical characteristics of patients hospitalized with COVID-19 and to investigate the association between clinical characteristics and echocardiographic parameters with in-hospital mortality.

The multicentre retrospective observational study included consecutive patients with confirmed diagnosis of COVID-19 admitted at seven Italian centers from 1 March to 22 April 2020. The baseline demographic, clinical, laboratory and TTE data were collected and recorded on an electronic datasheet. In all patients, demographic (age, gender, height, and weight), clinical (comorbidities, pharmacological therapy before and during hospitalization), laboratory (D-dimer, N-terminal pro-brain natriuretic peptide, and high-sensitivity troponin) and echocardiographic data were collected. TTE was performed in accordance with the current guidelines. Information on clinical course (admission in intensive care unit and respiratory support measures) and in-hospital complications were systematically recorded.

Out of the 1401 patients admitted at the participating centers with confirmed diagnosis of COVID-19, 226 (16.1%) underwent TTE and were included in the present analysis. In-hospital death occurred in 68 patients (30.1%). Low left ventricular ejection fraction (LVEF), low tricuspid annular plane systolic excursion (TAPSE), and acute respiratory distress syndrome ARDS were independently associated with in-hospital mortality.

The researchers concluded that TTE might be a useful tool in risk stratification of patients with COVID-19. Cardiovascular complications can negatively impact on outcomes of patients with COVID-19. Clinical and echocardiographic parameters such as LVEF, TAPSE, and ARDS might help to identify patients at higher risk for in-hospital mortality. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.

"Clinical and echocardiographic parameters of disease severity might help to determine which patients with COVID-19 are at higher risk for in-hospital mortality," said lead author Angelo Silverio, MD, of the University of Salerno, in Italy.

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University of Salerno