The association between transthoracic echocardiographic parameters and severity of COVID-19 in hospitalised adults-a retrospective analysis

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic with more than 220 million cases and 4.5 million deaths reported worldwide. Its clinical spectrum varies widely, and non-invasive prognostic markers are valuable as they can guide efficient resource allocation. Cardiovascular complications of COVID-19 include myocardial injury, acute heart failure, and arrhythmias. Both de novo cardiovascular complications and pre-existing cardiovascular co-morbidities are associated with a poor prognosis. Transthoracic echocardiography (TTE) can be used to assess cardiovascular structure and function non-invasively. Purpose: To investigate the association between TTE parameters and severity of disease in hospitalised adults with confirmed COVID-19 Methods: This single-centre retrospective analysis was conducted at a COVID-19 referral hospital in Indonesia. All consecutive adults hospitalised with confirmed COVID-19 who underwent TTE assessment between 3 April 2020 to 6 April 2021 were included. Comprehensive data including demographics, peak COVID-19 severity, pre-existing co-morbidities, and TTE findings were extracted from electronic medical records. Patients with mild-moderate and severe-critical disease were compared using the chi-square test and odds ratios (OR), with a confidence level of 95%. Results: A total of 488 patients were included in this study;202 with mild-moderate disease and 286 with severe-critical disease. Frequency of old age (>60 years), obesity, diabetes, chronic kidney disease, and congestive heart failure were higher in the severe-critical group (P < 0.05). On TTE assessment, Patients with severe-critical disease had higher odds of left ventricular hypertrophy (LVH) (OR 2.20;CI 1.49-3.24), LV wall motion abnormality (OR 3.33;CI 1.68-6.60), diastolic dysfunction (OR 1.46;CI 1.02-2.11), valve abnormality (OR 1.93;CI 1.27-2.92), and right ventricular (RV) dysfunction (OR 5.53;CI 1.63-18.73). After matching for age, obesity, and diabetes, patients with severe-critical COVID-19 continued to have higher odds of LVH (OR 1.91;CI 1.21-3.02), LV wall motion abnormality (OR 2.76;CI 1.28-5.96), diastolic dysfunction (OR 1.55;CI 1.00-2.38), and RV dysfunction (OR 3.86;CI 1.06-14.08). Conclusions: The presence of LVH, LV wall motion abnormality, diastolic dysfunction, and RV dysfunction on TTE assessment were associated with severe-critical disease in hospitalised adults with COVID-19. These findings must be validated in a larger prospective study. (Figure Presented).