• Denis Doyen, Pierre Dupland, Lucas Morand, Etienne Fourrier, Clément Saccheri, Matthieu Buscot, Hervé Hyvernat, Emile Ferrari, Gilles Bernardin, Alain Cariou, Jean-Paul Mira, Matthieu Jamme, Jean Dellamonica, and Mathieu Jozwiak.
• Service de Médecine Intensive Réanimation, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, Nice; Service de Cardiologie, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Nice; Equipe 2 CARRES, UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur UCA, Nice. Electronic address: doyen.d@chu-nice.fr.
• Chest. 2021 May 1; 159 (5): 1974-1985.

BackgroundCardiac injury has been reported in up to 30% of coronavirus disease 2019 (COVID-19) patients. However, cardiac injury is defined mainly by troponin elevation without description of associated structural abnormalities and its time course has not been studied.Research QuestionWhat are the ECG and echocardiographic abnormalities as well as their time course in critically ill COVID-19 patients?Study Design And MethodsThe cardiac function of 43 consecutive COVID-19 patients admitted to two ICUs was assessed prospectively and repeatedly, combining ECG, cardiac biomarker, and transthoracic echocardiographic analyses from ICU admission to ICU discharge or death or to a maximum follow-up of 14 days. Cardiac injury was defined by troponin elevation and newly diagnosed ECG or echocardiographic abnormalities, or both.ResultsAt baseline, 49% of patients demonstrated a cardiac injury, and 70% of patients experienced cardiac injury within the first 14 days of ICU stay, with a median time of occurrence of 3 days (range, 0-7 days). The most frequent abnormalities were ECG or echocardiographic signs, or both, of left ventricular (LV) abnormalities (87% of patients with cardiac injury), right ventricular (RV) systolic dysfunction (47%), pericardial effusion (43%), new-onset atrial arrhythmias (33%), LV relaxation impairment (33%), and LV systolic dysfunction (13%). Between baseline and day 14, the incidence of pericardial effusion and of new-onset atrial arrhythmias increased and the incidence of ECG or echocardiographic signs, or both, of LV abnormalities as well as the incidence of LV relaxation impairment remained stable, whereas the incidence of RV and LV systolic dysfunction decreased.InterpretationCardiac injury is common and early in critically ill COVID-19 patients. ECG or echocardiographic signs, or both, of LV abnormalities were the most frequent abnormalities, and patients with cardiac injury experienced more RV than LV systolic dysfunction.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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