In Total, 142 patients with diagnosis of Covid-19 infection, were enrolled who were admitted in Imam Reza Hospital, Mashhad, Iran. The mean age of participants was 60.69± 15.70 years (range: 30-90). Most patients were male (82, 57.7%). Known comorbidities were found in 45.1%, with hypertension (24.6%) and diabetes mellitus (23.9%) as the most common ones. The more frequent symptoms were dyspnea on admission (90.1%), cough (54.9%) and fever (49.3%). Baseline demographic characteristics, comorbidities, clinical and laboratory data were presented in Table 1.
LAD was the most common finding (15.5%) in ECG. Seventy-eight patients had sinus tachycardia (55%), one atrial fibrillation (0.7%) and two AVNRT (1.4%). Ten patients had right axis deviation (RAD) and others normal axis.
Bilateral peripheral ground glass opacification (GGO) was the most common specific CT scan manifestation (38%) followed by diffused bilateral GGO (35.2%), unilateral GGO (14.1%), and bilateral pleural effusion (9.9%). Other non-specific presentations were consolidation (63.4%), and lymphadenopathy (31%).
Abnormal TTE was seen in 71 cases (50%). Preserved left ventricle EF (EF=50-54%) was noted in 17 cases and reduced EF (EF<50%) in 8 (5.6%). Seventy-nine patients had mild diastolic dysfunction (56.3%), two of them moderate (1.4%) and others had normal diastolic function. Mild RV dilation was seen in 14 cases (9.9%) and moderate in two cases (1.4%). Mild pulmonary hypertension (PHT) was found in 12 subjects. Representative example of mild RV enlargement and mild PHT in a COVID-19 patient without prior cardiovascular disorder is shown in Figure2. Pericardial effusion was detected in 32 cases (22 minimal PE and 10 mild PE). The echocardiographic indices are shown in Table 2.
RV dysfunction was reported in 49 patients (34.5%) (39 mild RV dysfunction, 8 moderate, 2 severe). Table 3 demonstrates the patients’ characteristics stratified by RV function. RV size was correlated with O2 saturation (r= -0.302, P<0.001), TPI (r= 0.337, P=0.019), ESR (r=0.207, P= 0.035) and Platelet count (r= 0.355, P<0.001). CPK (P=0.033) and calcium (P=0.005) levels were significantly higher in patients with RV dysfunction.
Our findings demonstrated that SBP (OR: 0.885, P=0.006), DBP (OR: 1.24, P=0.003), male gender (OR: 0.40, P=0.004), higher age (OR: 1.37, P=0.002), smoking (OR: 0.011, P=0.035), addiction (OR: 0.011, P=0.011), hypertension (OR: 2.41, P=0.003), asthma (OR: 0.10, P=0.032), bilateral peripheral GGO (OR: 23.6, P=0.019) and coronary calcification (OR: 5.74, P=0.005) were predictors of in-hospital mortality. Moreover, age (OR: 1.29, P=0.002), hypertension (OR: 2.99, P=0.004) and bilateral peripheral GGO (OR: 26.81, P=0.023) were predictors of 30-day mortality.
In multivariate regression analysis, lower O2 saturation at the time of admission was independently predictor of re-admission (P<0.001). Furthermore, PASP (P=0.026), dyslipidemia (P=0.002) and RV dilation (P=0.037) were significantly predictors of in-hospital mortality (after adjusting for possible cofounders). RV enlargement (P<0.001), dyslipidemia (P<0.001), lower LVEF (P<0.001), older age (P=0.020), SBP (P=0.001), O2 saturation (P=0.018), shorter pulmonary acceleration time (PAT) (P=0.005) and diabetes (P=0.025) independently predicted 30-days mortality.
Patients with cardiac injury were mostly females (P=0.001), had hypertension (P=0.001), more comorbidities (P=0.026), bilateral peripheral GGO (P=0.001), RV dysfunction (P=0.029), a higher level of CPK (P=0.018) and coronary calcification (P=0.006), compared to those without. Likewise, in patients with cardiac injury, pericardial effusion was significantly more reported (16 versus one, P=0.021).
LV dysfunction (EF lesser than 55%) was seen in 17.6% of cases; probably most of them due to COVID-19 related cardiac injury.