Cardiac ultrasounds (also known as echocardiograms) are providing a view of the heart and the impact of the COVID-19 virus on patients. A new study by researchers at Icahn School of Medicine at Mount Sinai identifies different types of cardiac structural damage experienced by COVID-19 patients after cardiac injury that can be associated with deadly conditions including heart attack, pulmonary embolism, heart failure, and myocarditis. These abnormalities are associated with higher risk of death among hospitalized patients. The findings, published the October 26 issue of the Journal of the American College of Cardiology, offer new insights that may help doctors better understand the mechanism of cardiac injury, leading to quicker identification of patients at risk and guidance on future therapies.
"Early detection of structural abnormalities may dictate more appropriate treatments, including anticoagulation and other approaches for hospitalized and post-hospitalized patients," says author Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.
The international, retrospective study expands on Mount Sinai's previous research showing that myocardial injury (heart damage) is prevalent among patients hospitalized with COVID-19 and is associated with higher risk of mortality. That study focused on the patients' levels of troponin--proteins that are released when the heart muscle becomes damaged--and their outcomes (higher troponin levels mean greater heart damage).
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This new work looked at the presence of cardiac troponin elevations in combination with the presence of echocardiographic abnormalities, and found that the combination was associated with worse prognosis and mortality than troponin elevations alone.
"This is one of the first studies to provide detailed echocardiographic and electrocardiographic data in hospitalized patients with COVID-19 and laboratory evidence of myocardial injury," explains first and corresponding author Gennaro Giustino, MD, Cardiology Fellow at The Mount Sinai Hospital. "We found that among COVID-19 patients who underwent transthoracic echocardiography, these cardiac structural abnormalities were diverse and present in nearly two-thirds of patients."
Researchers looked at transthoracic echocardiographic (TTE) and electrocardiographic (ECG) scans of 305 adult patients with confirmed positive COVID-19 admitted to four New York City hospitals within the Mount Sinai Health System (The Mount Sinai Hospital, Mount Sinai West, Mount Sinai Queens, and Mount Sinai Beth Israel), Elmhurst Hospital in Queens, and two hospitals in Milan, Italy, between March and May 2020. Median age was 63 years and 67.2 percent were men. 190 patients (62.6 percent) had evidence of myocardial injury; 118 of them had heart damage at the time of hospitalization admission and 72 developed myocardial injury during hospitalization. Researchers found that patients with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers, and an increased prevalence of TTE abnormalities when compared to patients without heart injury.