Association between echocardiographic features and inflammatory biomarkers with clinical outcomes in COVID-19 patients in Saudi Arabia

Samah I Abohamr; Rami M Abazid; Mohammed K Alhumaid; Abubaker E Abdulrahim; Mubarak A Aldossari; Lamiaa Khedr; Rehab H Werida; Haifa S Alkheledan; Yazeed S Aleid; Sara W Abdelhamid; Abdulmohsen Al Mefarrej; Ahmed W Abdelhamid; Mohammad Hasan Alaboud; Omar T Alhasan; Hanem M Gomaa; Eman Elsheikh

doi:10.3389/fcvm.2023.1134601

Association between echocardiographic features and inflammatory biomarkers with clinical outcomes in COVID-19 patients in Saudi Arabia

Front Cardiovasc Med. 2023 May 26:10:1134601. doi: 10.3389/fcvm.2023.1134601. eCollection 2023.

Authors

Samah I Abohamr^{1

2}, Rami M Abazid³, Mohammed K Alhumaid⁴, Abubaker E Abdulrahim², Mubarak A Aldossari², Lamiaa Khedr¹, Rehab H Werida⁵, Haifa S Alkheledan⁶, Yazeed S Aleid², Sara W Abdelhamid⁷, Abdulmohsen Al Mefarrej², Ahmed W Abdelhamid⁷, Mohammad Hasan Alaboud², Omar T Alhasan², Hanem M Gomaa⁶, Eman Elsheikh¹

Affiliations

¹ Department of Cardiology, College of Medicine, Tanta University, Tanta, Egypt.
² Heart Health Center, King Saud medical city, Riyadh, Saudi Arabia.
³ Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University London, Ontario, ON, Canada.
⁴ King Fahad Medical City, Riyadh, Saudi Arabia.
⁵ Clinical Pharmacy & Pharmacy Practice Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt.
⁶ Infection Control Administration, King Saud Medical City, Riyadh, Saudi Arabia.
⁷ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Abstract

Background: Respiratory infections are one of the most common comorbidities identified in hospitalized patients. The coronavirus disease 2019 (COVID-19) pandemic greatly impacted healthcare systems, including acute cardiac services.

Aim: This study aimed to describe the echocardiographic findings of patients with COVID-19 infections and their correlations with inflammatory biomarkers, disease severity, and clinical outcomes.

Methods: This observational study was conducted between June 2021 and July 2022. The analysis included all patients diagnosed with COVID-19 who had transthoracic echocardiographic (TTE) scans within 72 h of admission.

Results: The enrolled patients had a mean age of 55.6 ± 14.7 years, and 66.1% were male. Of the 490 enrolled patients, 203 (41.4%) were admitted to the intensive care unit (ICU). Pre-ICU TTE findings showed significantly higher incidence right ventricular dysfunction (28 [13.8%] vs. 23 [8.0%]; P = 0.04) and left ventricular (LV) regional wall motion abnormalities (55 [27.1%] vs. 29 [10.1%]; p < 0.001) in ICU patients compared to non-ICU patients. In-hospital mortality was 11 (2.2%), all deaths of ICU patients. The most sensitive predictors of ICU admission (p < 0.05): cardiac troponin I level (area under the curve [AUC] = 0.733), followed by hs-CRP (AUC = 0.620), creatine kinase-MB (AUC = 0.617), D-dimer (AUC = 0.599), and lactate dehydrogenase (AUC = 0.567). Binary logistic regression showed that reduced LV ejection fraction (LVEF), elevated pulmonary artery systolic pressure, and dilated right ventricle were echocardiographic predictors of poor outcomes (p < 0.05).

Conclusion: Echocardiography is a valuable tool in assessing admitted patients with COVID-19. Lower LVEF, pulmonary hypertension, higher D-dimer, C-reactive protein, and B-type natriuretic peptide levels were predictors of poor outcomes.

Keywords: COVID-19; VEF; biomarker; echocardiography; mortality; outcome; pulmonary hypertension; thrombus.