Clinical Investigation
Echocardiography in COVID-19 Infection
Determining Which Hospitalized Coronavirus Disease 2019 Patients Require Urgent Echocardiography

https://doi.org/10.1016/j.echo.2021.03.010Get rights and content

Highlights

  • Most COVID-19 patients with normal troponin and BNP had no urgent TTE findings.

  • Troponin and BNP may help determine which patients can safely delay TTE.

Background

Patients hospitalized with coronavirus disease 2019 (COVID-19) often have abnormal findings on transthoracic echocardiography (TTE). However, although not all abnormalities on TTE result in changes in clinical management, performing TTE in recently infected patients increases disease transmission risks. It remains unknown whether common biomarker tests, such as troponin and B-type natriuretic peptide (BNP), can help distinguish in which patients with COVID-19 TTE may be safely delayed until infection risks subside.

Methods

Using electronic health records data and chart review, the authors retrospectively studied all patients hospitalized with COVID-19 in a multisite health care system from March 1, 2020, to January 15, 2021, who underwent TTE within 14 days of their first positive COVID-19 result and had BNP and troponin measured before or within 7 days of TTE. The primary outcome was the presence of one or more urgent echocardiographic findings, defined as left ventricular ejection fraction ≤ 35%, wall motion score index ≥ 1.5, moderate or greater right ventricular dysfunction, moderate or greater pericardial effusion, intracardiac thrombus, pulmonary artery systolic pressure > 50 mm Hg, or at least moderate to severe valvular disease. Stepwise logistic regression was conducted to determine biomarkers and comorbidities associated with the outcome. The performance of a rule for classifying TTE using troponin and BNP was evaluated.

Results

Four hundred thirty-four hospitalized and 151 intensive care unit patients with COVID-19 were included. Urgent findings on TTE were present in 105 patients (24.2%). Troponin and BNP were abnormal in 311 (71.7%). Heart failure (odds ratio, 5.41; 95% CI, 2.61–11.68), troponin > 0.04 ng/mL (odds ratio, 4.40; 95% CI, 2.05–10.05), and BNP > 100 pg/mL (odds ratio, 5.85; 95% CI, 2.35–16.09) remained significant predictors of urgent findings on TTE after stepwise selection. No urgent findings on TTE were seen in 95.1% of all patients and in 91.3% of intensive care unit patients with normal troponin and BNP.

Conclusions

Troponin and BNP were highly associated with urgent echocardiographic findings and may be used in triaging algorithms for determining in which patients TTE can be safely delayed until after their peak infectious window has passed.

Keywords

Transthoracic echocardiography
Safety
Risk stratification
COVID-19
Troponin
B-type natriuretic peptide

Abbreviations

BNP
B-type natriuretic peptide
COVID-19
Coronavirus disease 2019
ICU
Intensive care unit
LV
Left ventricular
TTE
Transthoracic echocardiography

Cited by (0)

Dr. Yuan was supported by the National Heart, Lung, and Blood Institute (grant T32 5T32HL116273-07). The funding organizations had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Conflicts of interest: None.

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