Transthoracic echocardiographic findings in patients admitted with SARS-CoV-2 infection
Transthoracic echocardiographic findings in patients admitted with SARS-CoV-2 infection
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DOI：
10.1111/echo.14835
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发表时间：
2020-09-19
影响因子：
1.5
通讯作者：
Abbas, Amr E.
中科院分区：
文献类型：
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作者：
Schott, Jason P.;Mertens, Amy N.;Abbas, Amr E.
简介 严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染患者的肌钙蛋白和 D-二聚体水平通常升高，但为了避免工作人员接触，现有的影像学检查无法支持最可能的病因。本研究的目的是报告 SARS-CoV-2 患者的经胸超声心动图 (TTE) 结果与肌钙蛋白和 D-二聚体水平的相关性。方法 我们确定了 66 名 SARS-CoV-2 患者（平均年龄 60 +/- 15.7 岁），他们在 6 周的时间里在一个拥有 8 家医院的大型医疗保健系统中接受了 TTE 治疗。 TTE 读者对观察者内和观察者间分析评估的实验室数据不知情。结果 1780 名 SARS-CoV-2 患者中有 66 名被纳入，属于高危人群，其中 38 名（57.6%）入住 ICU，47 名（71.2%）D-二聚体升高，41 名（62.1%）肌钙蛋白升高，25 名（37.9%）死亡。 49 名 (74.2%) 患者存在右心室 (RV) 扩张。中度/重度 RV 扩张与轻度/无 RV 扩张之间的发生率和平均 D-二聚体升高相似（69.6% vs 67.6%，P = 1.0；3736 +/- 2986 vs 4141 +/- 3351 ng/mL，P = .679）。 46 名患者 (69.7%) 存在左心室 (LV) 壁厚度增加，肌钙蛋白和平均肌钙蛋白水平升高的发生率与正常壁厚度相似 (66.7% vs 52.4%，P = .231；0.88 +/- 1.9 vs 1.36 +/- 2.4 ng/mL，P = .772)。左心室扩张很少见（n = 6，9.1%），新近降低的左心室射血分数也很罕见（n = 2，3.0%）。结论 SARS-CoV-2 患者的 TTE 稀缺，技术难度大，适合高危患者。 RV 扩张在 SARS-CoV-2 中很常见，但与 D-二聚体水平升高无关。左室壁厚度增加很常见，而新近降低的左室射血分数很少见，并且两者都与肌钙蛋白水平无关。
Introduction Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients commonly have elevated troponin and D-dimer levels, but limited imaging exists to support most likely etiologies in efforts to avoid staff exposure. The purpose of this study was to report transthoracic echocardiographic (TTE) findings in SARS-CoV-2 patients with correlating troponin and D-dimer levels. Methods We identified 66 SARS-CoV-2 patients (mean age 60 +/- 15.7 years) admitted within a large, eight-hospital healthcare system over a 6-week period with a TTE performed. TTE readers were blinded to laboratory data with intra-observer and inter-observer analysis assessed. Results Sixty-six of 1780 SARS-CoV-2 patients were included and represented a high-risk population as 38 (57.6%) were ICU-admitted, 47 (71.2%) had elevated D-dimer, 41 (62.1%) had elevated troponin, and 25 (37.9%) died. Right ventricular (RV) dilation was present in 49 (74.2%) patients. The incidence and average D-dimer elevation was similar between moderate/severe vs. mild/no RV dilation (69.6% vs 67.6%,P = 1.0; 3736 +/- 2986 vs 4141 +/- 3351 ng/mL,P = .679). Increased left ventricular (LV) wall thickness was present in 46 (69.7%) with similar incidence of elevated troponin and average troponin levels compared to normal wall thickness (66.7% vs 52.4%,P = .231; 0.88 +/- 1.9 vs 1.36 +/- 2.4 ng/mL,P = .772). LV dilation was rare (n = 6, 9.1%), as was newly reduced LV ejection fraction (n = 2, 3.0%). Conclusion TTE in SARS-CoV-2 patients is scarce, technically difficult, and reserved for high-risk patients. RV dilation is common in SARS-CoV-2 but does not correlate with elevated D-dimer levels. Increased LV wall thickness is common, while newly reduced LV ejection fraction is rare, and neither correlates with troponin levels.