Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

Stephen Huang, Philippe Vignon, Armand Mekontso-Dessap, Ségolène Tran, Gwenael Prat, Michelle Chew, Martin Balik, Filippo Sanfilippo, Gisele Banauch, Fernando Clau-Terre, Andrea Morelli, Daniel De Backer, Bernard Cholley, Michel Slama, Cyril Charron, Marine Goudelin, Francois Bagate, Pierre Bailly, Patrick-Johansson Blixt, Paul Masi, Bruno Evrard, Sam Orde, Paul Mayo, Anthony S McLean, Antoine Vieillard-Baron, ECHO-COVID research group, Anne-Marie Welsh, H Didriksson, Yoann Zerbib, Clément Brault, Laetitia Bodénes, Nicolas Ferrière, S Clavier, I Ma, Luigi La Via, Veronica Dezio, J B Rius, J R Palomares, Fernando Piscioneri, S Giglioli, S Banauch-Mayer, Bruno François, Anne-Laure Fedoux, Thomas Daix, Stephen Huang, Philippe Vignon, Armand Mekontso-Dessap, Ségolène Tran, Gwenael Prat, Michelle Chew, Martin Balik, Filippo Sanfilippo, Gisele Banauch, Fernando Clau-Terre, Andrea Morelli, Daniel De Backer, Bernard Cholley, Michel Slama, Cyril Charron, Marine Goudelin, Francois Bagate, Pierre Bailly, Patrick-Johansson Blixt, Paul Masi, Bruno Evrard, Sam Orde, Paul Mayo, Anthony S McLean, Antoine Vieillard-Baron, ECHO-COVID research group, Anne-Marie Welsh, H Didriksson, Yoann Zerbib, Clément Brault, Laetitia Bodénes, Nicolas Ferrière, S Clavier, I Ma, Luigi La Via, Veronica Dezio, J B Rius, J R Palomares, Fernando Piscioneri, S Giglioli, S Banauch-Mayer, Bruno François, Anne-Laure Fedoux, Thomas Daix

Abstract

Purpose: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).

Methods: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).

Results: Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU).

Conclusion: Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.

Keywords: COVID-19; Cardiac function; Echocardiography; Intensive care unit.

Conflict of interest statement

AVB declares research grant from GSK and Air Liquid companies. DDB declares honoraria from Philips company for lecture and honoraria for consulting from Edwards Lifesciences, Pfizer and Baxter companies. The other authors declare that they have no conflict of interest.

© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

Figures

Fig. 1
Fig. 1
A Mosaic plot for number of patients with different combinations of RV and LV functions (Hyper hyperkinetic, Norm normal, Mod dep moderately depressed, Sev dep severely depressed). Number denotes number of patients for each category. B Proportion of patients with depressed RV function with different LV function, both assessed visually. C Relationship between LVEF and TAPSE. The blue line shows the fitted linear regression line. Pearson correlation (R) is shown. D LV ejection fraction (LVEF) vs RV size
Fig. 2
Fig. 2
A LVEF in different age groups. Dashed line denotes LVEF = 50%. B TAPSE in different age groups. Dashed line denotes TAPSE = 17 mm
Fig. 3
Fig. 3
A Relationship between paradoxical septal motion (PSM) and right to left ventricular end-diastolic areas ratio (RVEDA/LVEDA). Dashed line denotes RVEDA/LVEDA = 0.6. B Mosaic plot showing the number of patients with different combinations of PSM and RV dilatation using RVEDA/LVEDA > 0.6 as cutoff. 90 patients had acute cor pulmonale by definition (presence of PSM and RVEDA/LVEDA > 0.6). C PaO2/FiO2 ratio in patients with vs without PSM. D PaO2/FiO2 ratio vs RV size assessed visually

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