The added predictive role of echocardiography in patients with mild or moderate Coronavirus Disease 2019

Lior Lupu, Ariel Banai, Yishay Szekely, Yael Lichter, Aviram Hochstadt, Philippe Taieb, Orly Sapir, Yoav Granot, Ilan Merdler, Eihab Ghantous, Ariel Borohovitz, Sapir Sadon, Erez Levi, Michal Laufer-Perl, Shmuel Banai, Yan Topilsky*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Aims: Recently, several therapeutic agents have decreased the progression to critical disease in patients with mild/moderate COVID-19. However, their use is limited to patients with ≥1 clinical risk factor. We aimed to evaluate echocardiographic features that may aid in risk stratification for patients with mild/moderate COVID-19. Methods: 278 consecutive patients with mild/moderate COVID-19 underwent prospective clinical and echocardiographic examination, ≤7 days of symptoms, as part of a predefined protocol. Analysis to identify echocardiographic predictors of outcome was performed. Results: In the multivariable risk model, E/e′, TAPSE, and pulmonary acceleration time (PAT) were associated with the composite outcome (p = 0.01, 0.005, 0.05, respectively). Stepwise analyses showed that the addition of echocardiography on top of having ≥1 clinical risk factor and even using each parameter separately improved the prediction of outcomes. If patients were re-categorized as high risk only if having both ≥1 clinical and ≥ 1 echocardiography risk parameter (E/e′ > 8, TAPSE<1.8 cm, PAT<90 msec), or even one echo parameter separately, then specificity, positive predictive value, and accuracy improved. If patients were re-classified as high risk if having either ≥1 clinical risk factor or ≥ 1 high-risk echocardiography parameter, all five individuals who were missed by the ≥1 risk factor “rule”, were correctly diagnosed as high risk. Similar analyses, including only patients with mild disease, showed that the addition of TAPSE improved the prediction of outcomes. Conclusions: In patients with mild/moderate COVID-19, a very limited echocardiographic exam is sufficient for improved outcome prediction, and may improve resource allocation for new anti-COVID-19 agents. Translational aspect of the work: We show that among patients with mild/moderate COVID-19, several easily obtained echocardiographic findings are strongly correlated with mortality or progression to the need for invasive/non-invasive mechanical ventilation, even when adjusted for the presence or absence of ≥1 clinical risk factor. Furthermore, even a limited echocardiographic exam is sufficient to develop a strategy of risk stratification. We believe that our data have important implications for the clinicians involved in the acute treatment of patients with COVID-19.

Original languageEnglish
Pages (from-to)492-499
Number of pages8
JournalInternational Journal of Cardiology
StatePublished - 15 Jan 2023


  • COVID-19
  • Echocardiography
  • Risk stratification


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