Heart scans and Covid-19: What the latest science says
- A study found that half of Covid-19 patients who underwent a heart scan had abnormalities
- 1 in 7 of these patients had severe cardiac disease
- The scans resulted in different treatment for about a third of patients
Heart disease has become a serious risk factor for Covid-19 patients, worsening their symptoms and increasing their risk of death.
The European Association of Cardiovascular Imaging (EACVI) recommended that heart scans should be limited in the current pandemic to prevent viral spread and reduced use of resources, but a group of scientists are saying that it's more important than ever to keep doing these scans.
Half of patients had abnormalities
Their research – commissioned by the British Heart Foundation and published in the European Heart Journal – found that about half of 1 216 Covid-19 patients from 69 countries that underwent echo heart scans had serious heart abnormalities, potentially leading to devastating complications.
The scans are normally requested when troponin levels are high – a type of protein the heart excretes when an injury occurs, like a heart attack.
These abnormalities included complications in the left and right ventricles (39% and 33% respectively), with severe abnormalities observed in one in seven patients.
New heart attacks, inflamed heart muscles and broken heart syndrome caused by stress were also found in smaller percentages.
Impact of previous history
Only about 23% of the participants had a previous history with heart issues, and in patients without previous history, 46% showed abnormalities, while 13% had severe disease.
"The pattern of cardiac injury observed in our survey appears to be consistent with the cardiovascular involvement observed in patients with other severe viral respiratory infections."
Those with abnormalities also tended to be older and had a higher prevalence of pre-existing ischaemic heart disease, heart failure, or valvular heart disease, but a similar prevalence of hypertension or diabetes mellitus.
Change in treatment
Just having had the scan changed the treatment outcome for about a third of all patients, showing how important it is not to limit heart scans when troponin levels are high.
"In patients in whom a change in management was reported, the echocardiogram led to changes in disease-specific therapy in 42%, such as initiating therapy for heart failure, acute coronary syndrome, tamponade, or pulmonary embolism, and commencing antimicrobial therapy for endocarditis," according to the researchers.
However, the study does not suggest that heart scans should be performed on all Covid-19 patients. Defined clinical indications were what necessitated the scans on the participants, like cardiac biomarkers that evaluate heart function and troponin levels.
It's also important to note there's some implicit bias regarding patient selection as their risk of heart complications is already high if they qualify for a heart scan in the first place.
"Building on this study, there is now a need for future imaging and biomarker studies to systematically investigate the cardiovascular manifestations of Covid-19, and to establish their true prevalence."
There's also a need to do follow-ups on those patients that have recovered, to see if Covid-19 causes any long-term cardiac damage. The survey will also continue to capture data from more countries like China.
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