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Cardiac Dysfunction in Critically Ill patients with COVID-19 – A Multicentre Observational Study
Jonatan Oras
Goteborgs universitet Institutionen for kliniska vetenskaper
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8890-6752
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This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: The importance of cardiac dysfunction in critically ill patients with COVID-19 is not well studied. The aim of the study was to assess the incidence, clinical risk factors, and prognosis of cardiac dysfunction in critical illness caused by COVID-19, and to evaluate if cardiac biomarkers can detect this condition.
Methods: This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 hours from admission to the ICU and again after four to seven days. Cardiac biomarkers and clinical data were collected at the time of echocardiography. Cardiac dysfunction was defined as either left ventricular (LV) dysfunction (having an ejection fraction < 50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (having a tricuspid annular plane systolic excursion (TAPSE) < 17mm or a moderate/severe RV dysfunction assessed visually).
Results: We included 132 patients of whom 94 (71%) were included prospectively. The vast majority were intubated (n=127). At the time of admission to ICU, 35 (27%) patients had cardiac dysfunction and 7 patients (5%) had cardiac dysfunction detected later in the ICU-period. LV dysfunction was found in 18 patients and RV dysfunction in 17 patients, 7 patients had both RV and LV dysfunction. Noradrenaline > 0.20µg/kg/min was the only clinical variable associated with a higher risk of cardiac dysfunction. RV dysfunction was associated with an increased risk of death in a risk-adjusted model (OR 3.98, p = 0.013). Troponin and N-terminal pro b-type natriuretic peptide (NTproBNP) had moderate values in detecting cardiac dysfunction (AUC 0.729 and AUC 0.744, respectively). A combination of troponin < 1.44 times the upper reference limit and NTproBNP < 857ng/L had 85% probability of excluding cardiac dysfunction.
Conclusions: Cardiac dysfunction is common in critically ill patients with COVID-19. Although not easily detected with clinical variables, cardiac biomarkers might be helpful. RV dysfunction is associated with an increased risk of death, these patients might benefit from further investigation or treatments.
Trial registration: Registered on 24 Aug 2020 at Clinicaltrials.gov; registration number NCT04524234.
Keywords
COVID-19, cardiac dysfunction, echocardiography, cardiac biomarkers, intensive care unit
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This is a list of supplementary files associated with this preprint. Click to download.
- Supplementaldata.docx
Additional material File name: Supplemental data File formal: Word-file (.docx) Title: Additional tables, patient treatment, study site description and echocardiographic protocol Description of data: Tables with predictors of cardiac dysfunction, outcomes other than death, and troponin and NTproBNP in patients with left and right ventricular dysfunction. Description of patient treatment and study site description. The echocardiographic protocol used in the study.
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CURRENT STATUS: Under Review
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Review #2 received
Received 19 Jan, 2021
Review #1 received
Received 17 Jan, 2021
Review #3 received
Received 17 Jan, 2021
Reviewer #4 agreed
On 13 Jan, 2021
Reviewer #3 agreed
On 04 Jan, 2021
Reviewer #2 agreed
On 03 Jan, 2021
Reviewer #1 agreed
On 03 Jan, 2021
Reviewers invited
Invitations sent on 01 Jan, 2021
Editor invited
On 28 Dec, 2020
Editor assigned
On 28 Dec, 2020
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On 28 Dec, 2020
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On 27 Dec, 2020
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Subject Areas
Critical Care & Emergency Medicine
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This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Cardiac Dysfunction in Critically Ill patients with COVID-19 – A Multicentre Observational Study
Jonatan Oras
Goteborgs universitet Institutionen for kliniska vetenskaper
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8890-6752
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 05 Jan, 2021
No community comments so far
Review #2 received
Received 19 Jan, 2021
Review #1 received
Received 17 Jan, 2021
Review #3 received
Received 17 Jan, 2021
Reviewer #4 agreed
On 13 Jan, 2021
Reviewer #3 agreed
On 04 Jan, 2021
Reviewer #2 agreed
On 03 Jan, 2021
Reviewer #1 agreed
On 03 Jan, 2021
Reviewers invited
Invitations sent on 01 Jan, 2021
Editor invited
On 28 Dec, 2020
Editor assigned
On 28 Dec, 2020
Submission checks complete
On 28 Dec, 2020
First submitted
On 27 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: The importance of cardiac dysfunction in critically ill patients with COVID-19 is not well studied. The aim of the study was to assess the incidence, clinical risk factors, and prognosis of cardiac dysfunction in critical illness caused by COVID-19, and to evaluate if cardiac biomarkers can detect this condition.
Methods: This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 hours from admission to the ICU and again after four to seven days. Cardiac biomarkers and clinical data were collected at the time of echocardiography. Cardiac dysfunction was defined as either left ventricular (LV) dysfunction (having an ejection fraction < 50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (having a tricuspid annular plane systolic excursion (TAPSE) < 17mm or a moderate/severe RV dysfunction assessed visually).
Results: We included 132 patients of whom 94 (71%) were included prospectively. The vast majority were intubated (n=127). At the time of admission to ICU, 35 (27%) patients had cardiac dysfunction and 7 patients (5%) had cardiac dysfunction detected later in the ICU-period. LV dysfunction was found in 18 patients and RV dysfunction in 17 patients, 7 patients had both RV and LV dysfunction. Noradrenaline > 0.20µg/kg/min was the only clinical variable associated with a higher risk of cardiac dysfunction. RV dysfunction was associated with an increased risk of death in a risk-adjusted model (OR 3.98, p = 0.013). Troponin and N-terminal pro b-type natriuretic peptide (NTproBNP) had moderate values in detecting cardiac dysfunction (AUC 0.729 and AUC 0.744, respectively). A combination of troponin < 1.44 times the upper reference limit and NTproBNP < 857ng/L had 85% probability of excluding cardiac dysfunction.
Conclusions: Cardiac dysfunction is common in critically ill patients with COVID-19. Although not easily detected with clinical variables, cardiac biomarkers might be helpful. RV dysfunction is associated with an increased risk of death, these patients might benefit from further investigation or treatments.
Trial registration: Registered on 24 Aug 2020 at Clinicaltrials.gov; registration number NCT04524234.
Figure 1
Figure 2