ABSTRACT
Background: Pulmonary embolism (PE) have a high prevalence in COVID-19 patients. Best medical therapy and follow-up of these patients are still undefined. Methods: We conducted a retrospective single centre study in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 in 267 patients admitted for COVID-19 who underwent to computed tomography pulmonary angiogram (CTPA) for suspected PE. In 48 of them PE was diagnosed (18.7%). We followed these patients to look for deaths, recurrent thromboembolic events or relevant clinical hemorrhages. Type and duration of anticoagulation were analyzed. Results: The median follow-up was 13 months (IQR 1-14) and 4 patients were lost to follow-up. 16 patients died (36.4%), 1 patient had a new thromboembolic event (2.3%) and 3 had relevant hemorrhagic events (6.8%). 26 were treated with direct oral anticoagulants (DOAC) (59%), 2 with warfarin (4.5%) and 15 with heparin (34%). Median duration of anticoagulation was 5.8 months (CI 95% 4.08-7.54). Patients treated with DOAC presented a lower mortality then patients treated with heparin (3.8% vs 83.3%;p<0.001). Conclusions: PE in COVID-19 patients seems to be related to a relevant increased risk of death. Long term anticoagulation with DOAC in patients discharge at home appears to be safe and effective.
ABSTRACT
Background/Introduction: The novel coronavirus disease (COVID-19) inpatient mortality rate is approximately 20% in the United States. Reports have described a wide pattern of abnormalities in echocardiograms performed in patients admitted with COVID-19. The role of premorbid transthoracic echocardiogram (TTE) in the prediction of COVID-19 severity and mortality is yet to be fully assessed. Purpose: To assess whether a pre-COVID TTE can identify patients at high risk of adverse outcomes who are admitted with COVID-19. Methods: All patients who underwent a TTE from one year to one month prior to an index inpatient admission for COVID-19 were retrospectively enrolled across five clinical sites. Demographic information, medical history, and laboratory data were included for analysis. Echocardiograms were analyzed by an observer blinded to clinical data. Linear and logistic regressions were performed to detect the association of variables with death, invasive mechanical ventilation, initiation of dialysis, and a composite of these endpoints during the COVID-19 admission. Outcomes were then adjusted for a risk score using inverse propensity weighting incorporating age, sex, diabetes, hypertension, obstructive sleep apnea, history of atherosclerotic cardiovascular disease, atrial fibrillation, diuretic use, and angiotensinconverting enzyme inhibitor or angiotensin receptor blocker use. Results: There were 104 patients (68±15 years old, 49% male, BMI 31.4±9.1kg/m2) who met inclusion criteria (baseline characteristics in Table 1). Mean time from TTE to positive SARS-CoV-2 PCR test was 139±91 days. Twenty-nine (28%) participants died during the index COVID-19 admission. There was no association of pre-COVID echocardiographic measures of systolic ventricular function with any endpoint. Diastolic function, as assessed by LV e', was associated with mortality (Table 2). There were 25 patients (24%) with a normal lateral e' (≥10cm/s);none died. There were 35 (34%) patients with LV e' lateral velocity <8 cm/s, of whom 15 (43%) died. LV e' lateral velocity <8 cm/s was associated with an unadjusted odds ratio of 7.69 (95% confidence interval [CI] 2.26-26.19) for death and 3.25 (95% CI 1.11-9.54) for the composite outcome. The odds ratio for death was 4.76 (95% CI 1.10-20.61) and 3.78 (95% CI 0.98-14.6) for the composite outcome after adjustment for clinical risk factors (Table 2). Conclusion: In patients with an echocardiogram prior to COVID-19, impaired diastolic function as represented by an abnormal LV e' lateral velocity was associated with both inpatient COVID-19 mortality and a composite outcome of death, mechanical ventilation, and initiation of dialysis, even after adjustment for multiple co-morbidities and medication use. Knowledge of the pre-COVID TTE results may help clinicians identify patients at higher risk of adverse outcomes during an admission for COVID-19. (Figure Presented).