The prevalence, risk factors and outcome of cardiac dysfunction in hospitalized patients with COVID-19
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LETTER
The prevalence, risk factors and outcome of cardiac dysfunction in hospitalized patients with COVID‑19 Yuman Li1,2, He Li1,2, Meng Li1,2, Li Zhang1,2* and Mingxing Xie1,2* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, Coronavirus disease 2019 (COVID-19) is an emerging outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although sharing considerable similarities with SARS, cardiac injury was more frequently reported in SARS-CoV-2 [1]. However, the incidence and clinical significance of cardiac insufficiency in COVID-19 have not yet been well described. The purpose of our study was to purse the prevalence, risk factors and outcome of cardiac dysfunction in hospitalized patients with COVID-19. We included 157 consecutive adult patients who were diagnosed with COVID-19. Clinical data were obtained from electronic medical records. Left ventricular (LV) and right ventricular (RV) structure and function were evaluated using bedside transthoracic echocardiography. Heart failure (HF) was classified into heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). The definitions of HF and RV dysfunction were based on the American Heart Association Guidelines [2, 3]. RV dysfunction was found in 40 (25.5%) unselected patients, 26 (28.9%) patients requiring high flow oxygen and 15 (41.7%) patients requiring mechanical ventilation. HF was presented in 28 (17.8%) unselected patients consisting of 24 (15.3%) HFpEF and 4 (2.5%) HFrEF, 22 (24.4%) patients requiring high flow oxygen and 11 (30.6%) patients requiring mechanical
*Correspondence: [email protected]; [email protected] 1 Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China Full author information is available at the end of the article Yuman Li, He Li and Meng Li contributed equally.
ventilation. 9 (5.7%) patients had biventricular dysfunction. Clinical and echocardiographic characteristics of patients with COVID-19 are shown in Supplementary Tables 1 and 2. Compared with patients without cardiac insufficiency,those with cardiac insufficiency had more comorbidities and complications as well as poorer prognosis. A multivariate logistic regression analysis revealed that acute respiratory distress syndrome (ARDS) was independently predictive of cardiac dysfunction (Supplementary Table 3), which contributed to higher mortality (Fig. 1a). Moreover, LV and RV dysfunction were more frequent in patients with elevated high-sensitivity troponin I (hs-TNI) than those without (Fig. 1b). During hospitalization, 23 patients died. The incidence of LV and RV dysfunction were higher in non-survivors than survivors (Fig. 1c). The mortality was 3.0% for patients without cardiac dysfunction and normal hs-TNI levels, 6.7% for those with cardiac dysfunction and normal hs-TNI levels, 13.3% for those without cardiac dysfunction but elevated hs-TNI levels, and 64.0% for
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