Pericardial Effusion in Hospitalized COVID Patients Indicates Worse Prognosis

Cardiac monitoring using clinical, laboratory, and imaging parameters can be used to help risk-stratify patients with COVID‐19. However, most reports on cardiac involvement focus on myocardial involvement, and reports describing pericardial disease are less common, mostly retrospective or based on systematic literature review, assessing only patients with clinically indicated echocardiographic examinations. The scope of pericardial involvement in COVID‐19 infection remains unknown Therefore, Dr Eihab Ghantous and his team conducted a study to evaluate the prevalence, associates, and clinical impact of pericardial involvement in hospitalized patients with COVID‐19.

In a prospective study with a predefined protocol, the researchers included 530 patients with COVID‐19 who underwent clinical and echocardiographic examination, irrespective of clinical indication. The protocol included clinical symptoms and signs suggestive of pericarditis, calculation of modified early warning score, ECG and echocardiographic assessment for pericardial effusion, left and right ventricular systolic and diastolic function, and hemodynamics. They identified predictors of mortality and assessed the adjunctive value of pericardial effusion on top of clinical and echocardiographic parameters.

Key findings of the study:

• Upon analysis, the researchers found that 75 patients (14%) had pericardial effusion, but only 17 patients (3.2%) met the criteria for acute pericarditis.
• They also found that pericardial effusion was independently associated with modified early warning score, brain natriuretic peptide, and right ventricular function.
• In nonadjusted analysis, they noted pericardial effusion was associated with excess mortality (hazard ratio, 2.44).
• In multivariate analysis, after adjustment for modified early warning score and echocardiographic and hemodynamic parameters, they observed a statistically nonsignificant association with mortality (hazard ratio, 1.86) and improvement in the model fit.
• They noted that the assessment of pericardial effusion combined with modified early warning score, left ventricular ejection fraction (LVEF), and tricuspid annular plane systolic excursion (TAPSE) independently predicted outcome (hazard ratio, 1.86) and improved model fit.

The authors concluded, "In hospitalized patients with COVID‐19, pericardial effusion is prevalent, but rarely attributable to acute pericarditis. It is associated with myocardial dysfunction and mortality. A limited echocardiographic examination, including left ventricular ejection fraction, tricuspid annular plane systolic excursion, and assessment for pericardial effusion, can contribute to outcome prediction."

For further information:

DOI: https://doi.org/10.1161/JAHA.121.024363

Keywords:

Pericardial effusion, acute pericarditis, COVID 19 infection, Coronavirus , SARS-CoV-2, echocardiography, LVEF, TAPSE, left ventricular ejection fraction, tricuspid annular plane systolic excursion, Journal of the American Heart Association.