Pericardial Involvement in Hospitalized Patients With COVID-19

Among hospitalized patients with COVID-19, pericardial effusion is common but rarely attributable to acute pericarditis or myocarditis, according to a study published in the Journal of the American Heart Association.

Researchers sought to determine the prevalence of pericardial involvement in patients hospitalized with COVID-19 of all disease grades, as well as its prognostic effect.

They prospectively analyzed consecutive adult patients (aged ≥18 years) admitted to a medical center in Tel Aviv, Israel, with COVID-19 infection from March 21, 2020, to September 16, 2020. Diagnosis of COVID-19 infection was confirmed by a positive reverse-transcriptase polymerase chain reaction assay.

The overall cohort included 530 patients (aged mean 63.1±18.3 years; 62% men) who had a clinical and echocardiographic evaluation. All patients had COVID-19 symptoms and were stratified according to mild or moderate disease (52%), severe disease (44%), and critical disease (4%).

Of the cohort, 75 patients (14.2%) had pericardial effusion, which was mild in 72 patients and moderate in 3. Among those with pericardial effusion, 22.7% had pericarditis, which was defined as having the combination of typical electrocardiogram changes (7 patients) or typical chest pain (12 patients).

Univariate and multivariable analysis indicated that pericardial effusion was independently associated with worse modified early warning score (MEWS), higher brain natriuretic peptide, and poorer right ventricular function.

Pericardial effusion was associated with mortality (hazard ratio [HR], 1.86 [95% CI, 0.95-3.5]; P =.06), and marginally improved the model fit in the nested model (P =.07 for χ² difference test) in multivariate analysis adjusted for echocardiographic variables, hemodynamic parameters, and MEWS.

Pericardial effusion was associated with mortality (HR, 2.3 [95% CI, 1.39-3.68]; P =.0007) and improved the model fit in the nested model (P =.0001 for χ² difference test) in multivariate analysis after adjustment for tricuspid annular plane systolic excursion (TAPSE) and ejection fraction.

Pericardial effusion was associated with mortality (HR, 1.86 [95% CI, 1.09-3.07]; P =.02) and improved the model fit in the nested model (P =.02 for χ² difference test) in multivariate analysis after adjustment for TAPSE, left ventricular ejection fraction, and MEWS.

Study limitations include the single-center design that enrolled only hospitalized patients with COVID-19. Also, pre-existing pericardial effusion cannot be excluded, which could lead to possible overestimation of the true incidence of pericardial effusion. Furthermore, pre-COVID-19 echocardiograms were not evaluated, and some of the findings may have preceded COVID-19 infection.

“Clinicians taking care of patients with COVID-19 can use a limited echocardiographic examination for risk stratification, including left ventricular ejection fraction, TAPSE, and the presence of pericardial effusion,” the researchers wrote.

Disclosure: This work was supported by a research grant from NOVARTIS Israel Ltd. Please see the original reference for a full list of disclosures.

Reference

Ghantous E, Szekely Y, Lichter Y, et al. Pericardial involvement in patients hospitalized with COVID-19: prevalence, associates, and clinical implications. J Am Heart Assoc. Published online March 21, 2022. doi: 10.1161/JAHA.121.024363

This article originally appeared on The Cardiology Advisor