Researchers from the Icahn School of Medicine at Mount Sinai in New York reported that in-hospital patients who develop a heart condition known as right ventricular (RV) dilation are more likely to die from COVID-19.
RV dilation happens when the right side of the heart enlarges and becomes unable to function efficiently. An earlier report by John Madias, a cardiology professor at Mount Sinai, revealed that the condition is often neglected when it shows on electrocardiogram (ECG) results. This is because doctors often focus on the left side of the heart when assessing heart failure.
The researchers looked at the health records of 110 COVID-19 patients treated at Mount Sinai Morningside from March 26 to April 22. They found that 31 percent of the patients had RV dilation, based on ECG findings. Of those patients, 41 percent died, while only 11 percent of those without RV dilation met the same fate.
In their preliminary report, which was published online in JACC: Cardiovascular Imaging, the team also noted that none of the patients with RV dilation had “significant differences in the prevalence of major comorbidities,” which include diabetes, hypertension and coronary artery disease.
“Clinicians can use bedside echocardiography as a readily available tool to identify patients with COVID-19 infection at the highest risk of adverse hospital outcomes,” explained lead author Dr. Edgar Argulian, who is also a cardiology professor at Mount Sinai.
The team used bedside ECG machines for all patients in the study. The resulting images were then interpreted by echocardiography attendings. At the time of the study, the average age of the participants was 66 years, with women comprising 36 percent of the cohort. In addition, around 30 percent of the patients were intubated and mechanically ventilated.
The team also looked at the CT angiograms results of those with RV dilation and found that five had signs of pulmonary embolism, or a blood clot lodged in an artery in the lung. This meant that the dilation was likely caused by multiple factors, including damage due to viral infection.
This finding is similar to what doctors at the Centre Hospitalier Universitaire de Besancon in France have reported previously. In their paper, which was published in Radiology, the French doctors detected acute pulmonary embolism in over 20 percent of their sampled patients.
“Our results suggest that patients with severe clinical features of COVID-19 may have associated acute pulmonary embolus [blockage],” the researchers concluded.
People with chronic illnesses, chief of which is cardiovascular disease, are considered at-risk populations for COVID-19. In fact, around 10 percent of patients with coronavirus also have heart disease, high blood pressure and diabetes. In comparison, patients with preexisting lung disease, such as chronic obstructive pulmonary disease (COPD) or asthma, account for only 6 percent of severe COVID-19 cases. (Related: High blood pressure and diabetes could be raising your coronavirus risk.)
But it's not just people with heart disease who can suffer from complications from COVID-19. Doctors have reported cases of heart failure in COVID-19 patients without preexisting conditions.
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