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Cardiac Structural and Functional Characteristics in Patients with Coronavirus Disease 2019: A Serial Echocardiographic Study
medRxiv - Cardiovascular Medicine Pub Date : 2020-05-18 , DOI: 10.1101/2020.05.12.20095885
Heng Ge , Mingli Zhu , Jing Du , Yong Zhou , Wei Wang , Wei Zhang , Handong Jiang , Zhiqing Qiao , Zhichun Gu , Fenghua Li , Jun Pu

BACKGROUND: Increasing attention has been paid to cardiac involvement in patients with coronavirus disease 2019 (COVID-19). Yet, scarce information is available regarding the morphological and functional features of cardiac impairments in these patients. METHODS: We conducted a prospective and serial echocardiographic study to investigate the structural and functional cardiac changes among COVID-19 patients admitted to the intensive care unit (ICU). From January 21 to April 8, 2020, a total of 51 ICU patients (31 critically ill and 20 severely ill) with confirmed COVID-19 were monitored by serial transthoracic echocardiography examinations. Outcomes were followed up until April 8, 2020. RESULTS: Of 51 ICU patients, 33 (64.7%) had cardiovascular comorbidities. Elevations of levels of cardiac biomarkers including high-sensitivity cardiac troponin-I (hs-cTnI) and brain natriuretic peptide were observed in 62.7% and 86.3% of patients, respectively. Forty-two (82.3%) had at least one left-heart and/or right-heart echocardiographic abnormality. The overall median left ventricular ejection fraction (LVEF) was 65.0% (IQR 58.0-69.0%), with most (44,86.3%) having preserved LVEF. Sixteen patients (31.4%) had increased pulmonary artery systolic pressure, and 14 (27.5%) had right-ventricle (RV) enlargement. During the study period, 12 (23.5%) patients died. LVEF was comparable between survivors and non-survivors, while non-survivors had more often pulmonary hypertension (58.3% vs. 23.1%; P=0.028) and RV enlargement (58.3% vs. 17.9%, P=0.011). Kaplan-Meier analysis demonstrated similar survival curves between patients with vs. without echocardiographic left-heart abnormalities (P=0.450 by log-rank test), while right-heart abnormalities had adverse impact on mortality (P=0.012 by log-rank test). CONCLUSIONS: Typical cardiac abnormality in ICU patients with COVID-19 was right-heart dysfunction with preserved LVEF. Echocardiographic right-heart dysfunction was associated with disease severity and increased mortality in patients affected by COVID-19.

中文翻译:

冠状病毒病患者的心脏结构和功能特征2019:超声心动图系列研究

背景:2019年冠状病毒病(COVID-19)患者的心脏受累越来越受到关注。然而,关于这些患者心脏功能障碍的形态和功能特征的可用信息很少。方法:我们进行了一项前瞻性和系列超声心动图研究,以调查重症监护病房(ICU)的COVID-19患者的心脏结构和功能改变。从2020年1月21日至4月8日,通过连续经胸超声心动图检查监测总共51例确诊COVID-19的ICU患者(31例重症和20例重症)。结果随访至2020年4月8日。结果:51例ICU患者中,有33例(64.7%)患有心血管合并症。分别在62.7%和86.3%的患者中观察到包括高敏感性心脏肌钙蛋白I(hs-cTnI)和脑钠尿素在内的心脏生物标志物水平的升高。42名(82.3%)至少有一名左心和/或右心超声心动图异常。总体左室射血分数(LVEF)为65.0%(IQR 58.0-69.0%),其中大多数(44,86.3%)保留了LVEF。16例(31.4%)的肺动脉收缩压升高,而14例(27.5%)的右心室(RV)增大。在研究期间,有12名(23.5%)患者死亡。LVEF在幸存者和非幸存者之间具有可比性,而非幸存者的肺动脉高压发生率更高(58.3%vs. 23.1%; P = 0.028)和RV增大(58.3%vs. 17.9%,P = 0.011)。Kaplan-Meier分析显示左超声心动图与无超声心动图患者之间的生存曲线相似(对数秩检验,P = 0.450),而右心异常对死亡率有不利影响(对数秩检验,P = 0.012) 。结论:ICU COVID-19患者的典型心脏异常是右心功能不全且LVEF保留。超声心动图右心功能障碍与疾病严重程度和受COVID-19影响的患者死亡率增加相关。
更新日期:2020-05-18
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