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

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 symbolscript 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 echocar-diographic examination, symbolscript days of symptoms, as part of a predefined protocol. Analysis to identify echocar-diographic predictors of outcome was performed.Results: In the multivariable risk model, symbolscript TAPSE, and pulmonary acceleration time (PAT) were associated with the composite outcome (p symbolscript 0.01, 0.005, 0.05, respectively). Stepwise analyses showed that the addition of echocardiography on top of having symbolscript 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 symbolscript clinical and symbolscript 1 echocardiography risk parameter symbolscript > 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 symbolscript clinical risk factor or symbolscript 1 high-risk echocardiography parameter, all five individuals who were missed by the symbolscript 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 symbolscript clinical risk factor. Furthermore, even a limited echocardiographic exam is sufficient to develop a strategy of risk stratifi-cation. We believe that our data have important implications for the clinicians involved in the acute treatment of patients with COVID-19.