Cardiac Structural and Functional Characteristics in Patients with Coronavirus Disease 2019: A Serial Echocardiographic Study

  1. Ge Heng
  2. Zhu Mingli
  3. Du Jing
  4. Zhou Yong
  5. Wang Wei
  6. Zhang Wei
  7. Jiang Handong
  8. Qiao Zhiqing
  9. Gu Zhichun
  10. Li Fenghua
  11. Pu Jun

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Abstract

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.

CLINICAL TRIAL REGISTRATION

Unique identifier: NCT04352842 .

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    SciScore for 10.1101/2020.05.12.20095885: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Hospital Ethics Commission approved the study protocol and waived written informed consent for emerging infectious diseases according to the regulation issued by the National Health Commission of the People’s Republic of China. Data Collection: All epidemiological, clinical, laboratory, and outcome parameters were prospectively collected with standardized data collection forms from an electronic medical records system.
    Consent: The Hospital Ethics Commission approved the study protocol and waived written informed consent for emerging infectious diseases according to the regulation issued by the National Health Commission of the People’s Republic of China. Data Collection: All epidemiological, clinical, laboratory, and outcome parameters were prospectively collected with standardized data collection forms from an electronic medical records system.
    Randomizationnot detected.
    BlindingAll echocardiography determinations were based on the observations of two independent experienced reviewers (J.D. and W.W.) who were blinded to other data.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistics: Data analyses were performed using SPSS 23.0 (SPSS Inc., Chicago, Illinois) and SAS version 9.2 (SAS Institute, Cary, North Carolina).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04352842CompletedEchocardiographic Manifestation in Patient With COVID-19 （EA…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.12.20095885v1 on medRxiv