Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel.
Circulation. 2020 Jul 28;142(4):342-353. doi: 10.1161/CIRCULATIONAHA.120.047971. Epub 2020 May 29.
Information on the cardiac manifestations of coronavirus disease 2019 (COVID-19) is scarce. We performed a systematic and comprehensive echocardiographic evaluation of consecutive patients hospitalized with COVID-19 infection.
One hundred consecutive patients diagnosed with COVID-19 infection underwent complete echocardiographic evaluation within 24 hours of admission and were compared with reference values. Echocardiographic studies included left ventricular (LV) systolic and diastolic function and valve hemodynamics and right ventricular (RV) assessment, as well as lung ultrasound. A second examination was performed in case of clinical deterioration.
Thirty-two patients (32%) had a normal echocardiogram at baseline. The most common cardiac pathology was RV dilatation and dysfunction (observed in 39% of patients), followed by LV diastolic dysfunction (16%) and LV systolic dysfunction (10%). Patients with elevated troponin (20%) or worse clinical condition did not demonstrate any significant difference in LV systolic function compared with patients with normal troponin or better clinical condition, but they had worse RV function. Clinical deterioration occurred in 20% of patients. In these patients, the most common echocardiographic abnormality at follow-up was RV function deterioration (12 patients), followed by LV systolic and diastolic deterioration (in 5 patients). Femoral deep vein thrombosis was diagnosed in 5 of 12 patients with RV failure.
In COVID-19 infection, LV systolic function is preserved in the majority of patients, but LV diastolic function and RV function are impaired. Elevated troponin and poorer clinical grade are associated with worse RV function. In patients presenting with clinical deterioration at follow-up, acute RV dysfunction, with or without deep vein thrombosis, is more common, but acute LV systolic dysfunction was noted in ≈20%.
关于 2019 年冠状病毒病（COVID-19）的心脏表现的信息很少。我们对连续因 COVID-19 感染住院的患者进行了系统和全面的超声心动图评估。
100 例确诊为 COVID-19 感染的患者在入院后 24 小时内接受了完整的超声心动图评估，并与参考值进行了比较。超声心动图研究包括左心室（LV）收缩和舒张功能以及瓣膜血流动力学和右心室（RV）评估，以及肺部超声。在临床恶化的情况下进行第二次检查。
32 名患者（32%）基线时超声心动图正常。最常见的心脏病理学是 RV 扩张和功能障碍（39%的患者），其次是 LV 舒张功能障碍（16%）和 LV 收缩功能障碍（10%）。肌钙蛋白升高（20%）或病情更差的患者与肌钙蛋白正常或病情更好的患者相比，LV 收缩功能没有明显差异，但 RV 功能更差。20%的患者病情恶化。在这些患者中，随访时最常见的超声心动图异常是 RV 功能恶化（12 例），其次是 LV 收缩和舒张功能恶化（5 例）。在 RV 衰竭的 12 例患者中，有 5 例诊断为股深静脉血栓形成。
在 COVID-19 感染中，大多数患者的 LV 收缩功能正常，但 LV 舒张功能和 RV 功能受损。肌钙蛋白升高和更差的临床分级与更差的 RV 功能相关。在随访中出现临床恶化的患者中，更常见的是急性 RV 功能障碍，伴有或不伴有深静脉血栓形成，但约 20%的患者出现急性 LV 收缩功能障碍。
