Imaging tool could help identify COVID-19 patients at risk for heart problems, study finds

TORONTO – New study suggests that a common imaging tool used to examine the heart may be useful in assessing COVID-19 patients at risk of developing heart problems that could increase the risk of heart failure or stroke cerebrovascular.

Researchers at Johns Hopkins Medicine in Maryland retrospectively examined about 80 COVID-19 patients and 34 patients without COVID-19, all of whom had received imaging tests called 2-D echocardiograms.

Echocardiograms use sound waves through a transducer placed on the patient’s chest to create images of the heart walls and valves, much like a bat uses echolocation to see.

A 2D echocardiogram captures the actual movement of the heart, in a cone-shaped “echo” that displays on a computer screen, allowing doctors to see the real-time movement of structures in the heart.

These imaging tests allowed researchers to observe various parts of the heart throughout patients’ illness and relate different patterns to individual patient outcomes.

Heart injuries have been associated with more serious outcomes for COVID-19 patients, but a link between heart irregularities and COVID-19 patients who suffer from heart damage has not been investigated before, according to the study.

The research was released in May in the Journal of the American Society of Echocardiography.

“These results show that COVID-19 hospital patients have reduced [left atrium] function compared to negative COVID-19 controls with a similar degree of severe illness, ”the study said.

The left atrium is where the heart receives oxygenated blood from the lungs. By measuring left atrium voltage through echocardiograms – ‘strain’ meaning a measure of how much the left atrium is moving to do its job – researchers found that the left atrium of COVID-19 patients was moving much less than control patients and could move less blood through it with each pump.

But left atrium function was further reduced in COVID-19 patients who also developed atrial fibrillation or flutter while hospitalized with the virus, with those patients showing 30% less function in their left atrium. Atrial fibrillation refers to an irregular, often rapid heartbeat that occurs when the heart chambers are out of sync.

Researchers say using echocardiography to monitor these problems could help identify them early on.

“Many patients already receive echocardiograms in the hospital; adding a stress analysis does not require any further analysis of the patient,” Erin Goerlich, cardiology researcher at Johns Hopkins University School of Medicine and first author of the new article, said in a press release. “So this is a safe and affordable new data point that can tell us who might develop atrial fibrillation.”

The blood of patients who developed atrial fibrillation also showed some differences from other COVID-19 patients, containing higher levels of troponin and NT-proBNP, “two known markers of cardiac stress,” the statement said.

“This tells us that COVID-19 patients with high levels of these biomarkers need to be followed more closely and may benefit from an echocardiogram,” Goerlich said.

The study suggested that “systemic inflammation in COVID-19” could be a contributing factor in this specific type of irregular heartbeat.

Although blood thinners are often used to treat people with atrial fibrillation, the researchers noted that this strategy was not tested in this study and more research is needed.

But pending future studies, it is possible that “it could lead to new therapies to prevent strokes and heart attacks in some COVID-19 patients who are most at risk,” Allison Hays, medical director of programs Echocardiography at Johns Hopkins Hospital and senior author of the published article, said in the statement.

“We are also actively studying how these effects on the heart might persist after infection with SARS-CoV-2,” she added. “It is important to know whether these strain and fractional drain measurements improve over time.”