Noninvasive assessment of cardiac changes in patients with coronavirus disease-19 (COVID-19) by bedside ultrasound

Ziqing Gao; Yongquan Huang; Wuzhu Lu; Xiaobo Chen; Xuefeng Li; Shushan Zhang; Zhongzhen Su

doi:10.21037/jtd-21-1961

Noninvasive assessment of cardiac changes in patients with coronavirus disease-19 (COVID-19) by bedside ultrasound

J Thorac Dis. 2022 Feb;14(2):423-430. doi: 10.21037/jtd-21-1961.

Authors

Ziqing Gao¹, Yongquan Huang¹, Wuzhu Lu¹, Xiaobo Chen¹, Xuefeng Li¹, Shushan Zhang¹, Zhongzhen Su^{1

2

3}

Affiliations

¹ Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
² Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
³ Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.

Abstract

Background: Patients with coronavirus disease-19 (COVID-19) are susceptible to cardiac complications, and cardiac ultrasound is the preferred noninvasive method for clinical cardiac structure and function assessment.

Methods: We performed a retrospective study of 34 patients with COVID-19 and analyzed their clinical data, biochemistry test results [creatine kinase-MB (CK-MB), cardiac troponin I (cTnI) and C-reactive protein (CRP)], and parameters of cardiac ultrasound [left atrium (LA), left ventricular end-diastolic dimensions (LVDD), right atrium (RA), right ventricle (RV), main pulmonary artery (MPA), left ventricular ejection fraction (LVEF), tricuspid valve (TV), pulmonic valve (PV) and pulmonary artery systolic pressure (PASP)]. We classified the patients based on their clinical symptoms (mild, moderate, severe, and critical groups), and compared the parameters. CK-MB and cardiac ultrasound parameters are presented as mean ± standard deviation and compared using the one-way ANOVA. CTnI is presented as counts (percentages) and compared using the χ² test, CRP is presented as [M (P₂₅, P₇₅)] [median (interquartile range)] and compared using nonparametric tests (Kruskal-Wallis test).

Results: As the disease progressed, the parameters of both biochemical blood tests and cardiac ultrasound changed regularly, manifested as enlargement of the LA, LVDD, RA, RV, and MPA and increased PASP, CRP, CK-MB, and cTnI. Of these parameters, CRP, LA, LVDD, MPA, and PASP of the severe group were more notably elevated than in the mild and moderate groups (P<0.05). The critical group more showed markedly increased CK-MB, cTnI, and RA than the other groups (P<0.05), and CRP, LA, LVDD, RV, MPA, and PASP rose more sharply than in the mild and moderate groups (P<0.05).

Conclusions: As COVID-19 progressed, patients developed an enlarged heart with expanded pulmonary arteries and elevated PASP. Bedside ultrasound can be used as a noninvasive assessment of these changes and for guidance of clinical treatment.

Keywords: Coronavirus disease-19 (COVID-19); cardiac ultrasound; myocardial damage.