Echocardiographic characterisation in critical Covid19 - an observational study

  1. Henrik Isackson
  2. Anders Larsson
  3. Miklos Lipcsey
  4. Robert Frithiof
  5. Frank A. Flachskampf
  6. Michael Hultström

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Abstract

Objective

We aimed to investigate the acute cardiac effects of severe SARS-CoV-2.

Methods

This is an observational study generated from the first 79 patients admitted to Uppsala intensive care due to respiratory failure with SARS-CoV-2 infection. 34 underwent echocardiography of which 25 were included in the study and compared to 44 non-echo patients. Exclusion was based on absence of normofrequent sinus rhythm and mechanical respiratory support. Biomarker analysis was carried out on all patients.

Results

Mortality was increased in the echo compared to non-echo group (44 % vs. 16%, p<0.05). Right sided dimensions and functional parameters were not affected. Tricuspid regurgitation velocity indicated how increased pulmonary artery pressure was associated with mortality (survivors (n=5): 2.51 ± 0.01 m/s vs. non-survivors (n=5): 3.06 ± 0.11 m/s, p<0.05). Cardiac markers and D-dimer correlated to initiation of echocardiography (hs-TnI (ng/L): echo (n=23): 133 ± 45 vs. non-echo (n=41): 81.3 ± 45, p<0.01; NTproBNP (ng/L): echo (n=25): 2959 ± 573 vs. non-echo (n=42): 1641 ± 420, p<0.001; D-dimer (mg/L): echo (n=25): 16.1 ± 3.7 vs. non-echo (n=43: 6.1 ± 1.5, p<0.01) and mortality (hs-TnI (ng/L): survivors (n=48): 59.1 ± 21 vs. non-survivors (n=17): 211 ± 105, p<0.0001; NT-proBNP (ng/L): survivors (n=47): 1310 ± 314 vs. non-survivors (n=20): 4065 ± 740, p<0.0001; D-dimer (mg/L): survivors (n=50): 7.2 ± 1.5 vs. non-survivors (n=18): 17.1 ± 4.8, p<0.01). All intervals refer to standard error of the mean. Tricuspid regurgitation velocity was correlated with troponin I (r=0.93, r 2 =0.74, p<0.001, n=10).

Conclusions

These results suggest that there is no clear negative effect on cardiac function in critical SARS-CoV-2. There are indications that pulmonary pressure elevation carries a negative predictive outcome suggesting pulmonary disease as the driver of mortality. Cardiac biomarkers as well as D-dimer carry predictive value.

Trial registration number

Patients were included in “Clinical trials NCT04316884 ”

Article summary

Strength and limitations of this study

  • -

    The patient body is recruited from all patients admitted to ICU in need of mechanical respiratory support independent of background which makes it relevant to clinical practice.

  • -

    The echocardiographic image acquisition was carried out by hospital assigned agents on clinical indication, which makes the results applicable in a clinical setting.

  • -

    Since the image acquisition was carried out on a clinical indication, the results may be skewed towards the false positive if applied to all Covid19 patients.

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    1. Version published to 10.1101/2021.07.23.21261025v3 on medRxiv
    2. ScreenIT

      SciScore for 10.1101/2021.07.23.21261025: (What is this?)

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

      Table 1: Rigor

      EthicsConsent: Informed consent was given på subject patients.
      Sex as a biological variablenot detected.
      Randomizationnot detected.
      Blindingnot detected.
      Power Analysisnot detected.

      Table 2: Resources

      Software and Algorithms
      SentencesResources
      Analysis was carried out offline, independent of clinical analysis results, on TomTec® software by the primary analyst and quality-controlled by a senior echocardiographer.
      TomTec®
      suggested: None
      All statistical analyses and graphs utilised GraphPad Prism 5.0.
      GraphPad
      suggested: (GraphPad Prism, RRID:SCR_002798)

      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
      NCT04316884RecruitingMechanisms for Organ Dysfunction in Covid-19

      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.

      Results from scite Reference Check: We found no unreliable references.

      About SciScore

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    3. Version published to 10.1101/2021.07.23.21261025v2 on medRxiv
    4. Version published to 10.1101/2021.07.23.21261025v1 on medRxiv