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      Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

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          Abstract

          Purpose

          Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).

          Methods

          Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).

          Results

          Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO 2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU).

          Conclusion

          Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00134-022-06685-2.

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          Most cited references28

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

            Maximilian Ackermann, Stijn Verleden, Mark Kuehnel … (2020)
            Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.
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              Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

              Giacomo Grasselli, Alberto Zangrillo, Alberto Zanella … (2020)
              In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
              Article 0 comments Cited 2760 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Antoine Vieillard-Baron:
                ORCID: http://orcid.org/0000-0002-4179-3583
                antoine.vieillard-baron@aphp.fr
                Journal
                Journal ID (nlm-ta): Intensive Care Med
                Journal ID (iso-abbrev): Intensive Care Med
                Title: Intensive Care Medicine
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0342-4642
                ISSN (Electronic): 1432-1238
                Publication date (Electronic): 21 April 2022
                Pages: 1-12
                Affiliations
                [1 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Intensive Care Medicine, Nepean Hospital, , The University of Sydney, ; Sydney, Australia
                [2 ]GRID grid.412212.6, ISNI 0000 0001 1481 5225, Medical-Surgical ICU, , Dupuytren Teaching Hospital, Inserm CIC 1435 and UMR 1092, ; 87000 Limoges, France
                [3 ]GRID grid.410511.0, ISNI 0000 0001 2149 7878, Service de Médecine Intensive Réanimation, Hôpitaux universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, , Université Paris-Est Créteil, ; 94000 Créteil, France
                [4 ]GRID grid.50550.35, ISNI 0000 0001 2175 4109, Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, , University Hospital Ambroise Paré, ; 92100 Boulogne-Billancourt, France
                [5 ]GRID grid.411766.3, ISNI 0000 0004 0472 3249, Service de Médecine Intensive Réanimation, , CHU Cavale Blanche Brest, ; Brest, France
                [6 ]GRID grid.5640.7, ISNI 0000 0001 2162 9922, Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, , Linköping University, ; Linköping, Sweden
                [7 ]GRID grid.4491.8, ISNI 0000 0004 1937 116X, Department of Anesthesiology and Intensive Care, , General University Hospital and 1st Medical Faculty, Charles University, ; Prague, Czechia
                [8 ]GRID grid.412844.f, ISNI 0000 0004 1766 6239, Department of Anesthesia and Intensive Care, , Policlinico-Vittorio Emanuele University Hospital, ; Catania, Italy
                [9 ]GRID grid.168645.8, ISNI 0000 0001 0742 0364, Division of Pulmonary, Critical Care and Allergy, Department of Medicine, UmassMemorial Medical Center, , The University Hospital for University of Massachusetts, ; Worcester, MA USA
                [10 ]GRID grid.411083.f, ISNI 0000 0001 0675 8654, Department of Anaesthesiology and Critical Care Medicine, , Vall d’Hebron University Hospital, ; Barcelona, Spain
                [11 ]GRID grid.7841.a, Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, , University of Rome, “La Sapienza”, Policlinico Umberto Primo, ; Viale del Policlinico, Rome, Italy
                [12 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, CHIREC Hospitals, , Université Libre de Bruxelles, ; Brussels, Belgium
                [13 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, , AP-HP and Université de Paris, ; 20 Rue Leblanc, 75015 Paris, France
                [14 ]GRID grid.134996.0, ISNI 0000 0004 0593 702X, Medical Intensive Care Unit, , Amiens University Hospital, ; Amiens, France
                [15 ]GRID grid.512756.2, ISNI 0000 0004 0370 4759, Division of Pulmonary, Critical Care and Sleep Medicine, , Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, ; Hofstra/Northwell, Hempstead, NY USA
                [16 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, INSERM, UMR 1018, Clinical Epidemiology Team, CESP, , Université de Paris Saclay, ; Villejuif, France
                Author information
                http://orcid.org/0000-0002-4179-3583
                Article
                Publisher ID: 6685
                DOI: 10.1007/s00134-022-06685-2
                PMC ID: 9022062
                PubMed ID: 35445822
                SO-VID: 8a382023-d807-4957-b7b9-db26693784cb
                Copyright © © Springer-Verlag GmbH Germany, part of Springer Nature 2022
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 19 January 2022
                Date accepted : 16 March 2022
                Categories
                Subject: Original

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: covid-19,intensive care unit,cardiac function,echocardiography
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: covid-19, intensive care unit, cardiac function, echocardiography

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