INTRODUCTION
Coronavirus disease 19 (COVID-19) pandemic has caused over 6 million
deaths worldwide and these figures are likely
underestimated1.
COVID-19 infection may spam from asymptomatic or mild and self-limiting
cases, to severe illness requiring hospitalization where COVID-19 may
trigger a multi-systemic infection involving different
organs2-5. The lungs
seem the most affected organ with possible development of interstitial
pneumonia requiring hospitalization and intensive care unit (ICU)
admission with mechanical ventilation in severe cases6-8. A substantial
cardiovascular impact in patients with COVID-19 has been repeatedly
demonstrated9; of note,
even patients not requiring hospitalization have shown some degree of
myocardial dysfunction with features of myocarditis on magnetic
resonance imaging10-13.
Severely ill COVID-19 patients admitted to ICU may experience
cardio-circulatory failure and a fair amount of them may need support
with catecholamine infusions. Different degrees of cardiac injury as
evaluated by
biomarkers14-16 or
echocardiography9,17have been reported for COVID-19 patients admitted to ICU. Several
patterns of cardiovascular dysfunction have also been described: from
signs of myocarditis or myocardial ischemia to significant hypovolemia
(due to pyrexia and prolonged fasting), from right ventricular (RV)
failure (influenced by mechanical ventilation and/or by micro/macro
pulmonary embolism) to septic cardiovascular dysfunction due to
super-imposed bacterial or fungal
infections10,11,13,18,19.
Moreover, a combination of these features could be coexistent in
severely ill patients with COVID-19. Interestingly, a gap of knowledge
exists regarding the feasibility of precise characterization of left
ventricular diastolic dysfunction (LVDD) according to the joint
recommendations from the European
Association of Cardiovascular Imaging (EACVI) and the American Society
of Echocardiography
(ASE)20 in this
population of patients, which are at high risk for both chronic LVDD
(i.e. history of hypertension and diabetes) or acute deterioration of
their LV diastolic function. Of note, in non-COVID-19 critically ill
patients, left ventricular diastolic dysfunction (LVDD) has received
attention for its association with
outcomes21-23, while
the same association has not been shown for left ventricular systolic
dysfunction (LVSD)24.
Echocardiography is crucial in diagnosing and grading LVDD and may help
distinguishing patterns of cardiovascular dysfunction, suggesting
therapeutic options, and tracking the changes with sequential
monitoring25.
Our single center joined the international ECHO-COVID
study17. With the
purpose to fully characterize LVDD, we also collected tissue Doppler
Imaging (TDI) and left atrial volume index (LAVI) data. Hereby, we
report the feasibility of full and simplified LVDD assessment in severe
COVID-19 patients admitted to ICU, the incidence of LVDD and its
association with mortality.