Critical Care and Shock

Transthoracic echocardiography outcomes in critical COVID-19 and association with symptom burden – a longitudinal cohort study

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Objective: To look for any relationship between severe/critical coronavirus disease 2019 (COVID-19) illness and post-discharge cardiac function, and also assess any correlation between this and post-COVID symptom burden.

Design: Observational cohort study with both retrospective and prospective components.

Setting: Intensive Care Unit (ICU) and subsequent outpatient clinic at a tertiary hospital in Western Sydney, New South Wales (NSW), Australia.

Patients: All patients admitted to the ICU with COVID-19 infection between 01 July 2021 and 31 December 2021 were included (n=89).

Interventions: The cohort was divided into survivors (n=61) and non-survivors (n=28). Those who underwent transthoracic echocardiography (TTE) (survivors, n=22; and non-survivors, n=23). The survivors who had an inpatient TTE were invited back for a repeat TTE and standardised symptom assessment questionnaire (COVID-19 Yorkshire Rehabilitation Scale [C19-YRS]). For all patients, demographic, clinical, biochemical, and pharmacologic data was collected.

Measurements and results: Eighty-nine patients were included in the initial dataset, of which 45 had a TTE whilst acutely unwell, and 22/45 survived to hospital discharge. There were no significant differences in the measured TTE parameters between survivors and non-survivors. Of the survivors with a follow-up TTE, the majority of the changes seen in the initial study had resolved. Despite this, there was still an appreciable symptom burden in the domains of fatigue, breathlessness, ability to independently do activities of daily living, and overall reduced perception of health.

Conclusions: In a cohort of critically unwell COVID-19 patients, there were no significant echocardiographic differences between survivors and non-survivors. For the survivors, whilst the majority of acute cardiac changes associated with COVID-19 infection resolved over time, however, there remained a significant symptom burden, including breathlessness and fatigability, suggesting a non-cardiac aetiology of these symptoms.