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Echocardiographic reports have described various degrees of ventricular dysfunction and pericardial effusion in these patients. We explored echocardiographic findings in hospitalized patients with COVID-19 and myocardial injury during the surge in New York City attributed to the Omicron variant.
We retrospectively enrolled consecutive patients with COVID-19 admitted between December 15, 2021, and January 26, 2022, who underwent clinically indicated transthoracic echocardiogram at Mount Sinai Morningside Hospital, New York, New York. Only patients with evidence of myocardial injury (defined as admission troponin I level >0.04 ng/ml, 99th percentile) were included. Echocardiograms were performed following a focused, time-efficient protocol with appropriate use of personal protective equipment and limited viral exposure time. Portable ultrasound machines were used: CX50 (Philips Medical Systems, Bothell, Washington) and Vivid S70 (General Electric Medical Systems, Milwaukee, Wisconsin). Echocardiograms were interpreted by experienced, board-certified echocardiography attending physicians. Significant myocardial injury was defined as a peak cardiac troponin I level exceeding 1 ng/ml. Continuous variables were presented as median and interquartile range (IQR). Categorical variables were presented as numbers (%) and compared using chi-square test.
A total of 61 patients were identified, including 15 (25%) with significant myocardial injury. The mean age was 71 ± 14.7 years, and 31 patients (51%) were women. A total of 23 patients (38%) were admitted to the intensive care unit, and 17 (28%) were mechanically ventilated at the time of echocardiographic examination. A total of 8 patients (13%) had a known history of coronary artery disease. The median troponin level was 0.15 (IQR 0.081 to 1.3) ng/ml overall and 3.2 (IQR 1.84 to 9.7) ng/ml in patients with significant myocardial injury. Left ventricular dysfunction, defined as regional and/or global systolic dysfunction, was present in 23 patients (38%). In these, 10 (16%) had regional wall motion abnormalities (median troponin level 1.01 ng/ml, IQR 0.062 to 3.73): 2 consistent with ST-elevation myocardial infarction, 7 with presumably new wall motion abnormalities consistent with non–ST-elevation myocardial infarction (angiographically proved 5), and 1 with preexisting wall motion abnormalities. No patients had a pattern suggestive of stress-induced cardiomyopathy. A total of 13 patients (21%) had global systolic dysfunction with ejection fraction <50% (median troponin level 0.34 ng/ml, IQR 0.09 to 2.1). Isolated right ventricular (RV) dilation and dysfunction were noted in 10 patients (16%) with a median troponin level of 0.18 ng/ml (IQR 0.1 to 9.2). None of these patients had preexisting RV dysfunction, and 3 patients (30%) had documented pulmonary embolism. In addition, 25 patients (41%) had no significant echocardiographic findings with preserved biventricular function and no pericardial effusion. The median troponin level in these patients was 0.11 ng/ml (IQR 0.07 to 0.33). The presence of more than trivial pericardial effusion was noted in 4 patients (7%) (1 patient with global systolic dysfunction and 3 patients with preserved biventricular functions, Figure 1).
In 15 patients with significant myocardial injury, 4 patients (27%) had left ventricular dysfunction (regional 2, global 2), 4 patients (27%) had isolated RV dysfunction, and 4 patients (27%) had biventricular dysfunction. The median troponin level in patients with significant myocardial injury and any ventricular dysfunction was 3.2 (IQR 1.94 to 12.4) ng/ml. Patients with significant myocardial injury were more likely to require mechanical ventilation (8 [53%] vs 9 [20%], p = 0.011) and had higher in-hospital mortality (10 [67%] vs 6 [13%], p <0.001). This is a small, retrospective, single-center study. Confirmatory advanced cardiac imaging and coronary angiography were lacking in several patients.
In conclusion, there is a spectrum of echocardiographic findings in hospitalized patients with COVID-19 with myocardial injury during the Omicron variant surge, similar to previous surges. Significant myocardial injury is associated with high morbidity and mortality.
The authors have no conflicts of interest to declare.
Echocardiographic findings in patients with COVID-19 with significant myocardial injury.