ABSTRACT
Background Biomarker-evidenced myocardial injury is common among patients with COVID-19 infection and confers an increased risk of mortality. Prevalence and incremental prognostic impact of myocardial dysfunction is unknown. Methods Consecutive COVID-19 patients undergoing clinical echocardiography during their index hospitalization at three New York City hospitals were studied. Images were analyzed by a central core lab blinded to all clinical data. LV dysfunction was defined as LVEF < 55% and RV dysfunction as TAPSE <1.6 cm or S’<10 mm/s. Results 733 patients (64 ± 15 years, 61% men) were studied. Myocardial injury (elevated troponin) occurred in 21% of patients, among whom either LV or RV myocardial dysfunction occurred in 72% (LV: 54%, RV:24%). Myocardial dysfunction was more common among patients with myocardial injury vs. without (LV: 54 vs. 32% p<0.001;RV: 24 vs. 10% p=0.001). During inpatient follow-up (median 15 [IQR 6-35] days), in-hospital mortality occurred in 34% with myocardial injury and 44% with LV or RV dysfunction vs. 23% without myocardial injury (p<0.001). Risk for death was greatest among patients with combined myocardial dysfunction and myocardial injury, and less with myocardial injury alone [Figure]. Conclusion Echo-evidenced myocardial dysfunction occurs in nearly three quarters of patients with myocardial injury and is a powerful predictor of in-hospital mortality. [Formula presented]