Indications for and Findings on Transthoracic Echocardiography in COVID-19

SS Jain, Q Liu, J Raikhelkar, J Fried, P Elias, TJ Poterucha, EM DeFilippis, H Rosenblum, EY Wang, B Redfors, K Clerkin, JM Griffin, EY Wan, M Abdalla, NA Bello, RT Hahn, D Shimbo, SD Weiner, AJ Kirtane, SK Kodali, D Burkhoff, LE Rabbani, A Schwartz, MB Leon, S Homma, MR Di Tullio, G Sayer, N Uriel and DE Anstey
J Am Soc Echocardiogr 2020

BACKGROUND: Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease.

METHODS: A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record.

RESULTS: Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions 10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation.

CONCLUSIONS: This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.

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