Cardiac ultrasounds (also known as echocardiograms) provide insight into the heart and the impact of the COVID-19 viruses in patients.
A new study by researchers at the Icahn School of Medicine at Mount Sinai identifies different types of structural cardiac damage experienced by patients with COVID-19 after cardiac injury that may be associated with deadly conditions, including heart attack, pulmonary embolism, heart failure and myocarditis . These abnormalities are associated with an increased risk of death among hospitalized patients. The results, published in the October 26, 2020 edition of Journal of the American College of Cardiology, offer new insights that can help doctors better understand the mechanism of cardiac injury, leading to faster identification of patients at risk and guidance on future therapies.
“Early detection of structural abnormalities can dictate more appropriate treatments, including anticoagulation and other approaches for hospitalized and post-hospitalized patients,” says author Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Chief Physician at Mount Sinai Hospital .
The international retrospective study expands on previous Mount Sinai research, showing that myocardial injury (cardiac injury) is prevalent among patients hospitalized with COVID-19 and is associated with an increased risk of mortality. That study focused on patients’ troponin levels – proteins that are released when the heart muscle is damaged – and its results (higher levels of troponin mean more damage to the heart).
This new work analyzed the presence of elevations in cardiac troponin in combination with the presence of echocardiographic abnormalities and found that the combination was associated with a worse prognosis and mortality than elevations in troponin alone.
“This is one of the first studies to provide detailed echocardiographic and electrocardiographic data in patients hospitalized with COVID-19 and laboratory evidence of myocardial injury,” explains first and corresponding author Gennaro Giustino, MD, cardiology fellow at Mount Sinai Hospital. “We found that among COVID-19 patients undergoing transthoracic echocardiography, these structural cardiac abnormalities were diverse and present in almost two-thirds of patients.”
Researchers analyzed transthoracic (TTE) and electrocardiographic (ECG) echocardiographic examinations of 305 adult patients with confirmed positive COVID-19 admitted to four New York City hospitals within the Mount Sinai Health System (The Mount Sinai Hospital, Mount Sinai West, Mount Sinai Queens and Mount Sinai (Beth Israel), Elmhurst Hospital in Queens and two hospitals in Milan, Italy, between March and May 2020. The average age was 63 years and 67.2% were men. 190 patients (62, 6 percent) had evidence of myocardial injury; 118 of them had cardiac damage at the time of hospitalization and 72 developed myocardial injury during hospitalization.The researchers found that patients with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and a high prevalence of TTE abnormalities when compared to patients without cardiac injury.
The abnormalities were diverse, with some patients exhibiting multiple abnormalities. 26.3 percent had right ventricular dysfunction (which may be associated with pulmonary embolism and severe respiratory failure), 23.7 percent had regional left ventricular wall movement abnormalities (which may be associated with heart attacks), 18, 4 percent had diffuse left ventricular dysfunction (which can be associated with heart failure / myocarditis), 13.2 percent had grade II or III diastolic dysfunction (a condition that leads to stiffer cardiac chambers) and 7.2 percent had pericardial effusions (extra fluid around the heart that causes abnormal heart pumping).
The study started to observe hospital mortality and elevated troponin levels. It shows that troponin elevation was 5.2 percent among patients without cardiac injury, compared with 18.6 percent for patients with myocardial injury but without echocardiographic abnormalities, and 31.7 percent for patients with myocardial injury that also had echocardiographic abnormalities. The researchers adjusted for other major complications of COVID-19, including shock, acute respiratory distress syndrome and kidney failure.
“Our study shows that an echocardiogram performed with adequate personal protection considerations is a useful and important tool in the early identification of patients at higher risk for COVID-19-related cardiac injury, who may benefit from a more aggressive therapeutic approach early in life. your hospitalization, ”says corresponding author Martin Goldman, MD, Arthur M. and Hilda A. Master Professor of Medicine (Cardiology) at the Icahn School of Medicine on Mount Sinai. “In addition, as this is a new disease with persistent symptoms, we plan to follow these patients closely using images to assess the evolution and, hopefully, the resolution of these heart problems.”
“Echocardiograms have been invaluable in providing critical information about patients who have multiple cardiac complaints. Echocardiography is the only imaging modality that can be taken to bed and used safely for patients, including those on ventilators, ”says Lori Croft, MD, Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine on Mount Sinai and Director of the Echocardiography Laboratory at Mount Sinai Hospital. “Our findings will help guide patient care at Covid-19 during a critical period.”
Reference: October 26, 2020, Journal of American College of Cardiology.