Role of Echocardiography in COVID-19 Patients

Abstract

Coronavirus disease-2019 (COVID-19) pandemic has created new challenges for the healthcare systems all over the world. The incidence of myocardial injury ranges between 7 and 20% in hospitalized COVID-19 patients. 1 The term myocardial injury applies to any patient in whom at least one cardiac troponin (cTn) concentration is above the 99th percentile upper reference limit. The death rate in COVID-19 patients with cardiac disease as comorbidity has around 10%. Myocardial injuries might be related to the fulminant cytokine release and systemic inflammation seen in severe COVID-19 cases. 2 The role of echocardiographer is crucial as echocardiography is an easily available non-invasive bedside modality to assess for cardiac involvement as well as cardiorespiratory interactions in patients with COVID-19. However, sonographers are also at risk of being infected during the performance of echocardiogram, due to the prolonged and close contact with COVID-19 patients. Hence, appropriate protective measures are necessary to enable the best medical care for patients while also maintaining the health of the sonographer, especially in the setting of a shortage of expert staff (sickness or quarantine after duty) and to prevent transmission to other staff and patients. This article presents a clinical case series of a range of cardiac involvement in COVID-19 and offers guidance on indications of echocardiogram and safe practices for performing safe and effective echocardiography during the COVID-19 pandemic, with particular focus on echocardiography of suspected or confirmed COVID-19 cases. Echocardiography during COVID-19 is a clinically useful tool. Due to concerns about transmission of disease during performing an echo, the procedure should be streamlined, performed by skilled practitioners who are not at high-risk for COVID-19 severe disease, and with a focus on obtaining the best possible transthoracic images.