Aortic valve calcification in echocardiography is a prognostic factor for short-term adverse outcomes in elderly patients with severe COVID-19: a retrospective cohort study.

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) has profoundly impacted the global population, particularly older adults. While cardiac structural and functional changes are known to affect COVID-19 prognosis, the clinical utility of echocardiography in elderly patients with severe COVID-19 remains understudied. Therefore, we designed this study to investigate the association between echocardiographic parameters and short-term adverse outcomes in these patients, with the aim of facilitating early identification of high-risk individuals.

METHODS

In this retrospective analysis, 75 elderly patients (≥60 years old) with severe COVID-19 receiving standard treatment were included. Patients were categorized into two groups: good prognosis (discharge within 2 weeks, n=56) and poor prognosis (disease progression to critical type or death, n=19). General information, hematological indicators and echocardiographic parameters of these patients were collected and compared. Logistic regression and least absolute shrinkage and selection operator (LASSO) regression analyses were performed to evaluate associations between echocardiographic parameters and prognosis.

RESULTS

The poor prognosis group exhibited significantly lower arterial partial oxygen pressure (PaO), oxygenation index (OI) values, and lymphocyte counts (Lym), along with elevated levels of C-reactive protein (CRP), procalcitonin (PCT), interleukin 6 (IL-6), cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimer (D-d) (P<0.05). Additionally, this group demonstrated reduced left ventricular ejection fraction (LVEF) and higher prevalence of aortic valve calcification (AVC) and aortic valve regurgitation (AVR) (P<0.05). After adjusting for age, gender, hypertension, diabetes, PaO, and CRP using logistic regression, AVC remained independently associated with poor prognosis [odds ratio (OR) =4.915, 95% confidence interval (CI): 1.266-19.085, P=0.02].

CONCLUSIONS

AVC in echocardiography is a strong independent predictor of adverse short-term outcomes in elderly patients with severe COVID-19. Routine echocardiographic screening for AVC in high-risk elderly populations may facilitate early identification of patients requiring intensified therapies and hemodynamic monitoring.