What new imaging data tells us about COVID-19 and heart damage

Cardiac structural abnormalities are common among hospitalized COVID-19 patients who undergo a transthoracic echocardiogram (TTE), according to new findings published in the Journal of the American College of Cardiology.

Prior studies focused on myocardial injury had not included much, if any, insight into medical imaging data, making the results less helpful to clinicians. The team behind this analysis hoped to address that shortcoming by taking a thorough look at the TTE findings of hospitalized COVID-19 patients.

The study included data from 305 patients who were treated in one of seven hospitals from March 5 to May 2, 2020. All patients had a confirmed COVID-19 diagnosis and underwent a TTE. The mean patient age was 63 years old and more than 67% were male. While

Overall, 62.6% of patients showed biomarker evidence of myocardial injury. While 61% of those patients showed signs of myocardial injury when they were initially admitted to the hospital, the other patients developed myocardial injury during the hospitalization.

“Patients with cardiac injury had a substantially greater prevalence of left ventricular, right ventricular and pericardial abnormalities,” wrote lead author Gennaro Giustino, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues. “Higher degrees of diastolic dysfunction were also more frequent in patients with myocardial injury, possibly reflecting the higher prevalence of hypertension and chronic kidney disease among these patients. ST-segment changes on the 12-lead electrocardiogram appeared to identify two different patterns of myocardial injury, with diffuse ST-segment changes associated with global biventricular dysfunction (possibly reflecting a diffuse myocardial inflammatory damage) and regional ST-segment changes associated with regional wall motion abnormalities (possibly reflecting regional ischemic damage of the myocardium due to macro- or microvascular thrombosis). Therefore, ECG and echocardiographic abnormalities in the context of the appropriate clinical scenario may help differentiate across the different etiologies of myocardial injury in COVID-19.”

Patients with myocardial injury, the authors added, tended to be older and were more likely to have hypertension, diabetes or chronic kidney disease.

Among patients without myocardial injury, the in-hospital mortality rate was 5.2%. For patients with myocardial injury and no TTE-detected cardiac structural abnormalities, that rate increased to 18.6%. And for patients with myocardial injury and TTE-detected abnormalities, it jumped all the way to 31.7%.

After adjusting for certain variables and running numerous calculations, the team concluded that myocardial injury with TTE-detected abnormalities was associated with an increased risk of in-hospital mortality. Myocardial injury and no TTE-detected abnormalities, however, was not associated with such a risk.