key: cord-0848654-znh2sqzg
authors: Catena, Cristiana; Colussi, Gianluca; Bulfone, Luca; Da Porto, Andrea; Tascini, Carlo; Sechi, Leonardo A.
title: Echocardiographic comparison of COVID-19 patients with or without prior biochemical evidence of cardiac injury after recovery
date: 2020-10-22
journal: J Am Soc Echocardiogr
DOI: 10.1016/j.echo.2020.10.009
sha: 853e48f5731e32d145e3bc2b4beb0275da88096a
doc_id: 848654
cord_uid: znh2sqzg

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Although COVID-19 involves primarily the respiratory system, evidence of pathological involvement of the heart during the acute phase of illness is rapidly growing. Cardiac injury has been demonstrated in COVID-19 patients by detection of changes in cardiac function and increased markers of myocardial damage. 1 Because most COVID-19 patients recover from illness, knowledge of the cardiac outcome of infection would be important. The goal of the study was to compare the cardiac structure and function of patients who recovered from COVID-19 with or without prior biochemical evidence of cardiac injury.

We examined 105 patients (age: 57±14 years; 56 males, 49 females) who had been hospitalized for COVID-19 at a University Hospital and were recruited after hospital discharge.

From March 15 to April 15, 2020, patients had presented with fever and/or respiratory symptoms and tested positive for the SARS-CoV-2 on a nasopharyngeal swab. Depending upon clinical severity, patients were admitted either to COVID-19 isolation units for clinical monitoring and oxygen support with high-flow nasal cannula or sub-intensive/intensive care units for mechanical ventilation. After discharge, echocardiography was done in consecutive patients that attended follow-up visits from April 15 to May 15, 2020. Patients who attended follow-up visits during that period were 61% of those who were discharged from March 15 to April 15, 2020 and therefore a selection bias can not be excluded. Echocardiography was performed with use of appropriate personal protective equipment 2 by investigators who were blinded to the clinical and laboratory data. 3 Structure of cardiac chambers and left and right ventricular systolic and diastolic function were assessed. The date of COVID-19 diagnosis was considered as the index date to calculate the timing of cardiac ultrasound examination that was performed after a median of 41 days (interquartile range:37-44 days). The study received approval from the Internal Review Board and all patients gave their written informed consent. Analysis was a comparison of cardiac data that were measured in patients with or without biochemical evidence of cardiac injury during hospitalization that was defined by the presence of measurable serum troponin I levels.

J o u r n a l P r e -p r o o f During hospitalization, 87 (83%) of 105 COVID-19 patients had troponin I levels below the lower limit of detection of 0.015 ng/ml, and the remaining 18 (17%) had measurable values (median:0.028 ng/ml; interquartile range:0.015-0.115). At hospital admission, 13 (72%) of 18 patients with measurable serum troponin I had severe respiratory failure (arterial oxygen saturation<93%; PaO 2 /FIO 2 <300) that required mechanical ventilation with either continuous positive airway pressure (n=5) or orotracheal intubation (n=8). Table 1 J o u r n a l P r e -p r o o f 

COVID-19 and the heart