Indications for Echocardiography in COVID-19 patients
The American Society of Echocardiography (ASE) and other clinical societies have established appropriate criteria for the use of echocardiography (ECHO) in patients admitted to the hospital[2].
Given increasing evidence for cardiovascular manifestations of COVID-19, and the increasing role of bedside focused cardiac ultrasound (FoCUS) in clinical management, there may be utility in performing a focused bedside ECHO among patients with COVID-19, especially in the critically ill[3–5]. Although performing an ECHO solely based on troponin elevation is not recommended, there is an increasing body of data suggesting that elevated troponin (>99thpercentile on admission) is an important predictor of mortality and length of hospital stay in patients with COVID-19[6–10]. Similarly, NT-ProBNP has also been found to be elevated among a significant number of patients with COVID-19 and is an important predictor of mortality[11]. A prospective international survey of 1216 patients from 69 countries revealed that abnormalities on ECHO were found most in patients who had a combination of indications (72%) followed by patients with chest pain and ST segment elevation on ECG (71%), elevated cardiac biomarkers (69%) and clinical suspicion for left or right ventricular failure. In a third of patients who had abnormal ECHO (33%), it resulted in a change of management towards disease specific therapy (42%). In another retrospective study, ECHO changed clinical management in 24.2% of patients who had undergone cardiac imaging when there was concern for a major cardiovascular event[12].