Imaging test may predict patients most at risk of some heart
complications from COVID-19

Date:
July 8, 2021
Source:
Johns Hopkins Medicine
Summary:
Researchers have shown that a type of echocardiogram, a common
test to evaluate whether a person's heart is pumping properly, may
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 for heart failure and stroke,
among other heart issues.



FULL STORY ========================================================================== Researchers at Johns Hopkins Medicine have shown that a type of
echocardiogram, a common test to evaluate whether a person's heart
is pumping properly, may 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 for heart failure
and stroke, among other heart issues. The new findings, published online
May 30 in the Journal of the American Society of Echocardiography,
also suggest that patients with COVID-19 who go on to develop atrial fibrillation more commonly have elevated levels of heart-related proteins called troponin and NT-proBNP in blood test samples.


==========================================================================
If further studies confirm the findings, "this could lead to new therapies
to prevent strokes and heart attacks in certain COVID-19 patients who
are at the highest risk," says Allison Hays, M.D., medical director
of echocardiography programs at The Johns Hopkins Hospital and senior
author of the published paper.

The COVID-19 pandemic has affected more than 170 million people around
the world, and previous studies of complications and long-term effects
of SARS-CoV- 2 infection have found that patients who are hospitalized
with COVID-19 have more than double the rate of arrhythmias, including
atrial fibrillation and atrial flutter, a similar rapid rhythm that can
lead to heart failure and stroke.

But exactly how the virus causes these heart complications, and who
is most at risk of developing atrial fibrillation because of COVID-19,
has been poorly understood.

In this study, Hays and her colleagues compared 80 patients with COVID-19
with 34 patients who did not have COVID-19 who were also treated at
The Johns Hopkins Hospital in the intensive or intermediate care units
for respiratory issues. None of the patients had a history of heart
arrhythmia.

In the study, carried out between March and June 2020, the researchers
analyzed echocardiograms of hospitalized patients, applying a special
kind of analysis called speckle-tracking strain to determine how well
the left atrium of the heart moves with each heartbeat.



==========================================================================
The team found that, overall, patients with COVID-19 had reduced function
of their left atrium, the chamber of the heart that receives oxygenated
blood from the lungs. Left atrial strain -- a measure of the movement
of the left atrium's walls -- was significantly lower in patients with
COVID-19 (28.2% compared with 32.6%, p=0.026; normal >38%) and left atrial emptying fraction -- a measure of how much blood the atrium empties with
each contraction -- was also lower in the patients with COVID-19 (55.7% compared with 64.1%, p<0.001).

Moreover, left atrial strain was even lower among the 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% compared
to 30.4%, p<0.001). This suggests that speckle-tracking analysis --
and specifically, left atrial strain measurement.

"A lot of patients already get echocardiograms while in the hospital; the addition of strain analysis requires no extra scanning of the patient,"
says Erin Goerlich, M.D., a cardiology fellow at the Johns Hopkins
University School of Medicine and first author of the new paper. "So
this is a safe and affordable new data point that can clue us in about
who might develop atrial fibrillation." Echocardiograms cost on average
about $2,000, and are generally covered by health insurance.

When the researchers looked at the blood of patients with COVID-19 who developed atrial fibrillation, they saw some differences compared with
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 heart stress.

"This tells us that COVID-19 patients with high levels of these biomarkers should be followed more closely and may benefit from an echocardiogram,"
says Goerlich.



==========================================================================
Hays cautioned that the current study didn't test whether treating
patients with COVID-19 with blood thinners could help prevent the
complications that can result from atrial fibrillation, which has been suggested by some clinicians.

Blood thinners are generally prescribed to atrial fibrillation patients
to lower the risk of blood clots and strokes.

However, the new study suggests that treating certain people -- those
with especially low left atrial strain, for instance -- could be one
path forward.

More research is needed in this area, Hays says.

"We're also actively studying how these effects on the heart might
persist after SARS-CoV-2 infection," she adds. "It's important to know
whether those measures of strain and emptying fraction improve over time."
In addition to Allison Hays and Erin Goerlich, other authors on the JASE
paper are Anum Minhas, Nisha Gilotra, Andreas Barth, Monica Mukherjee,
Allyso Parziale and Katherine Wu of the Johns Hopkins University School
of Medicine.

The research was supported by a Ruth L. Kirschstein Institutional National Research Service Award (T32HL007227); the National Heart, Lung, and Blood Institute (T32HL007024 and 1R01HL147660); the Magic That Matters Fund
of Johns Hopkins Medicine; and a Johns Hopkins Clinician Scientist Award.

========================================================================== Story Source: Materials provided by Johns_Hopkins_Medicine. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Erin Goerlich, Anum Minhas, Nisha Gilotra, Andreas S. Barth, Monica
Mukherjee, Allyson Parziale, Katherine C. Wu, Allison G. Hays. Left
atrial function in patients with COVID-19 and its association
with incident atrial fibrillation/flutter. Journal of the American
Society of Echocardiography, 2021; DOI: 10.1016/j.echo.2021.05.015 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/07/210708170342.htm

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