Echocardiography in COVID-19 patients and its impact on treatment change

Background COVID-19 interacts at multiple levels with the cardiovascular system. The prognosis of COVID-19 infection is known to be worse for patients with underlying cardiovascular diseases. Furthermore, the virus is responsible for many cardiovascular complications. Myocardial injury may affect up to 20% of critically ill patients. However, echocardiography's impact on the management of patients affected by COVID-19 remains unknown. Objectives To explore echocardiography's impact on the management of COVID-19 patients. Methods This study was conducted from March 24th to April 14th 2020, in a single centre at Adolphe-de-Rothschild Foundation Hospital, Paris, France. All consecutive inpatients with laboratory and/or CT COVID-19 diagnosis were included in this study. Patients’ characteristics (clinical, biological and imaging) and treatment change induced by echocardiography were collected and analysed. Patients with and without treatment change induced by echocardiography were compared. Results A total of 56 echocardiographies in 42 patients with highly suspected or confirmed COVID-19 were included in the final analyses. The median age was 66 (IQR: 60.5–74). Echocardiography induced a treatment change in 9 cases (16%). The analysed clinical data were not associated with any treatment change induced by echocardiography. D-dimer and troponin levels were the only biological predictors of induced treatment change. On echocardiography, higher systolic pulmonary arterial pressures and documented cardiac thrombi were associated with treatment changes in these patients. Conclusions Echocardiography may be useful for the management of selected COVID-19 patients, especially those with elevated D-Dimer and troponin levels, in up to 16% of patients.