Clinical, Biochemical, and Echocardiographic Characteristics of Severe SARS-COV-2 Infection: Correlates of In-hospital Morbidity and Mortality

Background: Patients with cardiovascular disease are more susceptible to coronavirus disease 2019 (COVID-19) and have worse outcomes when infected. While multiple studies have reported an association between biochemical myocardial injury and consequent adverse events, these studies have been limited by a lack of echocardiographic data. This study reports a comprehensive echocardiographic evaluation of patients with severe COVID-19 at a large quaternary care hospital in New Jersey. Methods: Clinical, biochemical, and echocardiographic features of consecutive patients with severe COVID-19 undergoing echocardiography were studied. Clinical outcomes data including length of stay, requirement of mechanical ventilation, and in-hospital mortality were collected. Results: 987 patients with confirmed COVID-19 infection were treated at our institution of which 197 consecutive patients (20%) underwent echocardiographic evaluation. The median age of the cohort was 64 years. 38% of these patients were females, 23% had known CAD, and 21% had CKD. 55% of patients required mechanical ventilation and 49% required vasopressors, representing a critically-ill patient population with significant mortality of 44% during the index hospitalization. There was a high prevalence of echocardiographic abnormalities including right ventricular dilation (30%) or dysfunction (23%), left ventricular dysfunction (24%), and pericardial effusion (14%). Multiple biomarkers including troponin T, pro-BNP, D-dimer and CRP were strongly associated with echocardiographic abnormalities and in-hospital mortality. On Cox regression analysis, age (HR 1.03/year),pre-existing CAD (HR 2.7), and mechanical ventilation (HR 2.64) were the strongest independent predictors of in-hospital mortality. Conclusions: Severe COVID-19 infection is accompanied by a significant burden of echocardiographic abnormalities that are strongly correlated with higher degrees of inflammation and biomarker elevation. Additional investigation is warranted in assessing the role of a biomarker-guided approach for early cardiac surveillance using echocardiography to further risk stratify patients and tailor adjunctive therapy.