Researchers at Johns Hopkins Medicine have shown that a type of echocardiogram, a common test to assess whether a person’s heart is pumping properly, can be useful in predicting which patients with COVID-19 are most at risk of developing atrial fibrillation. , an irregular heartbeat that can increase a person’s risk of heart failure and stroke, among other heart problems. The new findings, published online May 30 at Journal of the American Society of Echocardiography, they also suggest that patients with COVID-19 who continue to develop atrial fibrillation more frequently have elevated levels of heart-related proteins called troponin and NT-proBNP in blood test samples.
If further studies confirm the results, “this could lead to new therapies to prevent strokes and heart attacks in certain patients with COVID-19 who are most at risk,” says Allison Hays, MD, medical director of echocardiography programs. ‘Johns Hopkins Hospital and lead author of the published paper.
The COVID-19 pandemic has affected more than 170 million people worldwide and previous studies on complications and long-term effects of SARS-CoV-2 infection have found that hospitalized patients with COVID-19 have more than double of arrhythmia rate, included atrial fibrillation i atrial flutter, a fast pace similar to what it can cause heart attack and stroke.
But it has not been understood exactly how the virus causes these heart complications and who is most at risk of developing atrial fibrillation due to COVID-19.
In this study, Hays and colleagues compared 80 patients with COVID-19 with 34 patients who did not have COVID-19 who were also treated at Johns Hopkins Hospital in the intensive or intermediate care units for respiratory problems. . None of the patients had a history of cardiac arrhythmia.
In the study, conducted between March and June 2020, researchers analyzed echocardiograms of hospitalized patients, applying a special type of analysis called a stain tracking strain to determine how well the left atrium of the heart moves with every heartbeat.
The team found that, in general, patients with COVID-19 had reduced function of the left atrium, the chamber of the heart that receives oxygenated blood from the lungs. Left atrial tension – a measure of left atrial wall movement – was significantly lower in patients with COVID-19 (28.2% compared with 32.6%, p = 0.026; normal> 38%). ) and the left atrial emptying fraction, a measure of how much blood empties the atrium with each contraction, was also lower in patients with COVID-19 (55.7% compared with 64.1%, p
In addition, left atrial tension was even lower among 30% of patients with COVID-19 who developed atrial fibrillation or flutter during their hospital stay compared with other patients with COVID-19 (22.3 % versus 30.4%, p
“Many patients already receive echocardiograms in the hospital; the addition of strain analysis does not require any additional patient examination,” says Erin Goerlich, MD, a cardiology member at Johns Hopkins University School of Medicine and lead author. of the new role. “So this is a new safe and affordable data point that can give us an idea of who might develop atrial fibrillation.” Echocardiograms cost an average of about $ 2,000 and are usually covered by health insurance.
When the researchers examined the blood of COVID-19 patients who developed atrial fibrillation, they saw some differences compared to other patients with COVID-19. People who developed atrial fibrillation had higher levels of troponin (0.07 versus 0.03, p = 0.011) and NT-proBNP (946 versus 231, p = 0.0007), two known markers of stress. cardiac.
“This tells us that COVID-19 patients with high levels of these biomarkers should be followed more closely and can benefit from an echocardiogram,” Goerlich says.
Hays warned that the current study did not test whether treating patients with COVID-19 with anticoagulants could help prevent complications that may result from atrial fibrillation, as some clinicians have suggested. Anticoagulants are usually prescribed for atrial fibrillation patients to reduce the risk of blood clots and stroke.
However, the new study suggests that treating certain people (e.g., those with especially low left atrial tension) could be a way forward. More research is needed in this area, Hays says.
“We are also actively studying how these effects affect color may persist after SARS-CoV-2 infection, “he adds.” It’s important to know if these strain and vacuum fraction measurements improve over time. ”
Erin Goerlich et al, Left atrial function in patients with COVID-19 and its association with incident / flutter atrial fibrillation, Journal of the American Society of Echocardiography (2021). DOI: 10.1016 / j.echo.2021.05.015
Johns Hopkins University School of Medicine
Citation: Imaging Test Can Predict Patients at Higher Risk of Some Cardiac Complications by COVID-19 (2021, July 8) Retrieved July 8, 2021 at https://medicalxpress.com/news/2021-07 -imaging-patients-heart-complications- covid-.html
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