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Clinical, Biochemical and Echocardiographic Characteristics of Severe SARS-COV-2 Infection-Correlates of In-hospital Morbidity and Mortality
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  • Sabha Bhatti,
  • Justin Johanessen,
  • Ikenna Erinne,
  • Kulin Shah,
  • Ayesha Salahuddin,
  • Abdul Hakeem
Sabha Bhatti
Rutgers Robert Wood Johnson Medical School New Brunswick
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Justin Johanessen
Rutgers Robert Wood Johnson Medical School New Brunswick
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Ikenna Erinne
Rutgers Robert Wood Johnson Medical School New Brunswick
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Kulin Shah
Rutgers Robert Wood Johnson Medical School New Brunswick
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Ayesha Salahuddin
Rutgers Robert Wood Johnson Medical School New Brunswick
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Abdul Hakeem
Rutgers Robert Wood Johnson Medical School New Brunswick
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Abstract

Background: Patients with cardiovascular disease are more susceptible to coronavirus disease 2019 (COVID-19) and have worse outcomes when infected. This study reports the largest and most comprehensive echocardiographic evaluation of patients with severe COVID-19 at a quaternary care hospital in the second most affected state in the US, New Jersey. Methods: Clinical, biochemical and echocardiographic features of consecutive patients with severe COVID-19 undergoing echocardiography were studied. Clinical outcome data including length of stay, requirement of mechanical ventilation and in-hospital mortality were collected. Results: 987 patients with confirmed COVID-19 infection were treated at our institution of which 146 consecutive patients (15%) underwent echocardiographic evaluation. Median age was 63 years ;37% were females, 21% had known CAD and 20% had CKD. 57% of patients required mechanical ventilation and 50% required vasopressors . 31% of patients died during the index hospitalization. There was a high prevalence of echocardiographic abnormalities including right ventricular dilation (33%) or dysfunction (21%), left ventricular dysfunction (20%), and pericardial effusion (13%). Multiple biomarkers including troponin T, pro BNP, dimer and CRP were strongly associated with echocardiographic abnormalities and in-hospital mortality. On Cox regression analysis, age (HR 1.04/year) and CAD (HR 2.4) were independent predictors of mortality. Conclusions: Severe COVID-19 infection is accompanied by a significant burden of echocardiographic abnormalities that are strongly correlated with higher degrees of inflammation and biomarker elevation. Additional investigation is warranted in assessing the role of a biomarker-guided approach for early cardiac surveillance using echocardiography in further risk stratifying patients and tailoring adjunctive therapy.

Peer review status:IN REVISION

28 Jul 2020Submitted to Echocardiography
28 Jul 2020Assigned to Editor
28 Jul 2020Submission Checks Completed
04 Aug 2020Reviewer(s) Assigned
19 Aug 2020Review(s) Completed, Editorial Evaluation Pending
21 Aug 2020Editorial Decision: Revise Major