Half of COVID-19 Patients Have Heart Abnormalities: Imaging Survey

A troubling new survey of echocardiographic findings in COVID-19 patients revealed that half of the patients in the study had heart abnormalities.

“Early case reports suggest that COVID-19 can cause a wide range of cardiac conditions that include acute myocardial infarction, myocarditis, and takotsubo cardiomyopathy […],” they wrote in the paper. “However, the incidence of these cardiac complications and the subsequent implications for treatment and resource allocation are unknown. Consequently, there is an urgent need to better understand the interactions between COVID-19 and the heart.”

The prospective international survey, published in the European Heart Journal: Cardiovascular Imaging, evaluated echocardiographic findings captured in patients with presumed or confirmed COVID-19 during a three-week period in April 2020. The authors recorded patient characteristics, indications, findings, and the impact of echocardiographic management. The analysis included 1,216 patients from 69 countries.

The authors reported that overall, 667 (55%) of patients included in the analysis showed abnormal echocardiograms. They reported left and right ventricular abnormalities in 470 (39%) and 397 (33%) of patients, respectively, as well as myocarditis in 35 (3%) and evidence of new myocardial infarction in 36 patients (3%). They also reported takotsubo cardiomyopathy in 19 (2%) of patients and severe cardiac disease (defined as severe ventricular dysfunction or tamponade) in 182 (15%) of patients. In the 901 patients without pre-existing cardiac disease, there were abnormal echocardiograms in 46% of patients and severe disease in 13%. They authors reported independent predictors of left and right ventricular abnormalities, including elevated natriuretic peptides (adjusted OR=2.96; 95% CI, 1.75 to 5.05) and also cardiac troponin (OR=1.69; 95% CI, 1.13 to 2.53) for left ventricular abnormalities, and severity of COVID-19 symptoms (OR=3.19; 95% CI, 1.73 to 6.10) for right ventricular abnormalities. The echo data changed management in 33% of the patients, the researchers said.

“In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography,” they wrote. “Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.”

The researchers did note some study limitations.

“Our study suffers from the usual limitations associated with an observational survey,” they wrote. “Whilst by design we sought to conduct a rapid survey capturing key echocardiographic findings during the pandemic’s peak, this limited the amount and granularity of the data we could capture.”