Echocardiographic characteristics of COVID-19 patients without history of structural heart disease-in relation to cardiac biomarkers and short-term in-hospital outcome-preliminary results

ABSTRACT

INTRODUCTION It is well known that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions and troponin elevation in critically ill patients. The insight into the cardiovascular involvement and sequelae in those with no preexisting conditions is poor. We performed a systematic and comprehensive echocardiographic evaluation of patients hospitalized with COVID-19. The aim of the study was to analyze cardiac performance in subjects with no prior history of structural heart disease in relation to inflammatory markers and clinical outcome. The study is a part of CRACoV project, with prospective design and an assumed 12-month follow-up. Following data are preliminary results of baseline examinations. MATERIAL AND METHODS The study included 106 patients hospitalized with diagnosed COVID-19 infection (age 56.7 ± 12,8 years;39 women). Patients with prior heart failure, known structural heart disease, acute coronary syndrome, acute stroke or acute vascular episode as well as chronic kidney disease, chronic inflammatory or neoplasmatic disease were excluded from the study. In all participants standard clinical assessment and laboratory tests including C-reactive protein (CRP), interleukin 6 (IL-6), cardiac troponin I, N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were performed. Severity of the disease was classified according to World Health Organization criteria. An extended echocardiographic image acquisition protocol was performed in all subjects within 72-hours from admission. All analyses, including left ventricle (LV) longitudinal deformation (GLS), were performed off-line. RESULTS COVID-19 had severe course in 58 subjects, 4 patients in critical condition died during hospitalization. High-flow oxygen therapy was required in 17 subjects. LV systolic function was preserved in all subjects (mean 62.3 ± 5.2%;GLS -19.9 ± ± 6.4;CO 5.51 ± 1.47 l/min). Averaged E/Eè was 6.97 ± 1.80. Right ventricle (RV) was enlarged in 6 patients, in all RV function was preserved (TAPSE 24.6 ± 3.74 mm, RV S' 15.6 ± 3.03 mm). In one patient RV thrombus was detected. Pericardial effusion was present in 8 patients. Elevated NT-pro-BNP (>300 pg/ml) was detected in 34 patients and elevated troponin in 3 subjects. NT-pro-BNP significantly correlated with CRP (r = 0.24;P <0.01);IL-6 (r = 0.28;P <0.01) and negatively with LV GLS (r = -0.27;P = 0.01). In multiple regression the risk of high-flow oxygen therapy was related with male gender (b = -0.30;P = 0.04), CRP (b = 0.50;P <0.005), NT-pro-BNP (b = -0.28;P = 0.04) and RV diameter (b = 0.33;P = 0.02). CONCLUSIONS In subjects with COVID-19 and normal LV systolic function, elevation of NT-pro-BNP is frequent and reflects haemodynamic stress related with acute inflammatory disease. NT-pro-BNP significantly associates with the risk of severe course of COVID-19. RV diameter is independently related with worse prognosis in COVID-19.