Around half of COVID-19 patients who received an echocardiogram in-hospital showed abnormalities in heart function, according to a prospective international survey funded by the British Heart Foundation and published in the European Heart Journal‒Cardiovascular Imaging. The study, authored by Marc Dweck (University of Edinburgh, Edinburgh, UK), found that around one in seven showed severe abnormalities likely to have a major effect on their survival and recovery.
It also showed that one in three patients who received an echocardiography scan had their treatment changed as a result. The findings suggest that heart scans could prove crucial for identifying patients who may benefit from additional treatments to improve their COVID-19 recovery and prevent potential long-term damage to their heart, the Foundation said in a press release.
Marc Dweck, the study’s lead author and British Heart Foundation senior lecturer and consultant cardiologist at the University of Edinburgh (Edinburgh, UK), said: “COVID-19 is a complex, multisystem disease which can have profound effects on many parts of the body, including the heart. Many doctors have been hesitant to order echocardiograms for patients with COVID-19 because it’s an added procedure which involves close contact with patients. Our work shows that these scans are important – they improved the treatment for a third of patients who received them.”
Researchers from the British Heart Foundation Centre of Research Excellence at the University of Edinburgh looked at echocardiogram results of 1,216 patients from 69 countries with COVID-19.The scan results were sourced from many Covid-19 hotspots around the world, allowing researchers to urgently understand the impact of Covid-19 on the heart while the pandemic was at its peak.
In the study, over half (55%) of patients, including those with pre-existing heart disease, showed abnormal changes to the way their heart was pumping, with around one in seven showing evidence of severe dysfunction. The majority (901) had no known heart disease before the study and showed similar changes. Almost half (46%) and one in eight (13%) showed abnormal changes and severe dysfunction respectively. These changes were observed for the first time during the patients’ COVID-19 illness and the researchers believe they could be due to the effects of the virus.
Results showed that left ventricular abnormalities were reported in 479 (39%) patients, with echocardiographic evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Left ventricular impairment was classified as mild, moderate, or severe in 17, 12, and 9% of patients, respectively. Right ventricular abnormalities were reported in 397 (33%) patients, with mild or moderate right ventricular impairment in 19% and severe impairment in 6%.
Right ventricular dilatation (15%), elevated pulmonary artery pressures (8%), and a D-shaped left ventricle (4%) were reported less frequently. Cardiac tamponade and endocarditis were reported in 11 (1%) and 14 (1%) patients, respectively. Severe cardiac disease, defined as severe left or right ventricular dysfunction or cardiac tamponade, was reported in 1 in 7 patients (n = 182, 15%).
In the study, one third of patients had their treatment changed as a result of the echocardiogram. This included being given medicines for heart failure, or more careful control of fluids and therapy designed to support heart function.
The researchers point out several limitations to the study given its observational design. During the pandemic the number of scans being carried out would have been balanced with the risk of exposing staff, patients and equipment to the virus, they note, and patients who received the scans were in hospital and had suspected heart complications, usually because they had abnormal blood markers reflecting heart damage. This study does not tell us how common heart changes are in people who did not receive a scan.