Severe acute respiratory syndrome coronavirus 2 (COVID-19) created substantial diagnostic and logistical strains in clinical practice. Early in the pandemic, cardiac injury emerged as a recognized complication of SARS-CoV-2 infection, prompting evaluation of the role of transthoracic echocardiography (TTE) to define cardiac involvement and guide care. In this context clinicians and systems needed evidence about which echocardiographic findings carried prognostic value and whether use of imaging adhered to established Appropriate Use Criteria (AUC).
The authors conducted a retrospective cohort study to evaluate prognostic predictors detectable by TTE and to assess adherence to AUC for echocardiography in a high-burden COVID-19 setting. The study analyzed medical records of patients with confirmed COVID-19 who underwent TTE, collecting socio-demographic, biochemical, and echocardiographic data. The primary outcome reported was mortality. The investigators also measured inter-observer agreement (Kappa statistic) for classification of TTE indications according to American College of Cardiology Foundation 2011 and American Society of Echocardiography 2020 guidance, and they assessed whether TTE resulted in a subsequent change in patient management.
A total of 149 hospitalized patients with confirmed COVID-19 who received TTE were included. Median age was 66 years (interquartile range, IQR: 56–73). Median length of hospital stay was 13 days (IQR: 6–23). Reported overall in-hospital mortality was 39.6%, and mortality among patients treated in the intensive care unit was 60%.
TTE indications were classified using AUC drawn from ACCF 2011 and ASE 2020 guidelines. Inter-observer agreement for assigning indications by these criteria was high (κ ≥ 0.798), indicating reliable reproducibility between observers when determining whether each TTE met the AUC. The study also recorded whether TTE findings prompted a change in clinical management, which was considered a measure of clinical impact.
Several laboratory markers were associated with mortality in this cohort. Elevated leukocyte and neutrophil counts, higher lactate dehydrogenase (LDH), and increased C-reactive protein (CRP) correlated with worse outcomes. Among echocardiographic parameters, the study identified right ventricular (RV) dilatation and/or strain as the only echocardiographic finding that was significantly predictive of mortality (P = 0.008). The abstract presents RV pathology as a quantifiable prognostic indicator in hospitalized patients with COVID-19.
Inter-observer agreement for AUC-based classification of TTE indications was reported as high (kappa ≥ 0.798), supporting consistent application of guideline criteria between reviewers. Importantly, TTE findings led to a documented change in clinical management in 79.7% of the cases, indicating that echocardiographic information frequently influenced treatment decisions in this population.
The authors conclude that RV pathology, specifically dilatation and/or strain detected by TTE, is a strong and measurable prognostic marker among hospitalized COVID-19 patients. Although AUC demonstrated high inter-observer reliability, the frequent and meaningful changes in management following TTE suggest that existing guideline-based AUC may not fully capture the acute prognostic needs created by severe COVID-19. The findings support the clinical relevance of focused assessment of the right ventricle when imaging patients with COVID-19 and suggest that TTE can yield actionable information in most cases.
The PubMed abstract provides key results but does not report some methodological specifics in detail. Information not reported in the abstract includes the exact inclusion and exclusion criteria, the timing of TTE relative to symptom onset or hospital admission, the specific echocardiographic measures and thresholds used to define RV dilatation or strain, adjustment variables used in multivariable analyses (if performed), and longer-term follow-up beyond in-hospital mortality. The full text would need to be consulted for these details.