Abnormal Echocardiographic Findings in Hospitalized Patients with Covid-19: A Systematic Review and Meta-analysis

Abstract Background Coronavirus disease 2019 (Covid-19) can lead to severe respiratory distress and acute cardiac injury, but it is unclear how often it can cause cardiac dysfunction. Objective In this systematic review, we aimed to summarize the main echocardiographic findings in patients with Covid-19. Methods We systematically searched in PUBMED, EMBASE, LILACS and Cochrane databases, in addition MedRxiv and Scielo preprints from inception to July 21st, 2021. Studies reporting echocardiographic data in patients with Covid-19 were included. Demographic characteristics, previous cardiovascular disease (CVD), and echocardiographic findings were extracted. We performed a meta-analysis of proportions to estimate the main echocardiographic findings. The level of significance was p < 0.05. Results From 11,233 studies, 38 fulfilled inclusion criteria and were included in the meta-analysis. The estimated proportions of left ventricular (LV) systolic dysfunction were 25% (95%CI: 19, 31; I293%), abnormal global longitudinal strain 34% (95% CI 23, 45; I290%), righ ventricular (RV) systolic dysfunction 17% (95%CI 13, 21; I290%), pericardial effusion 17% (95%CI: 9, 26; I297%), and pulmonary hypertension 23% (95%CI: 15, 33, I2 96%). LV systolic dysfunction was directly associated with study-specific prevalence of previous abnormal echocardiogram (p<0.001). The proportion of patients in mechanical ventilation, indicating severity of disease, did not explain the heterogeneity in the proportions of LV dysfunction (p=0.37). Conclusion Among hospitalized patients with Covid-19, LV dysfunction has been reported in one quarter, with smaller proportions of right ventricular dysfunction, pericardial effusion and pulmonary hypertension. However, there was a higher proportion of LV dysfunction among studies reporting the presence of prior heart disease, which suggests that cardiac dysfunction was mostly pre-existing.

**摘要 背景** 新型冠状病毒肺炎（Coronavirus Disease 2019, COVID-19）可引发严重呼吸窘迫与急性心肌损伤，但目前尚不明确其导致心功能不全的发生频率。
**目的** 本系统综述旨在总结新型冠状病毒肺炎患者的主要超声心动图表现。
**方法** 本研究系统检索了PubMed、EMBASE、LILACS、Cochrane数据库，以及MedRxiv和Scielo预印本平台，检索时限为建库至2021年7月21日。纳入报道新型冠状病毒肺炎患者超声心动图数据的研究。提取研究的人口统计学特征、既往心血管疾病（Cardiovascular Disease, CVD）史及超声心动图表现。采用比例Meta分析估算主要超声心动图异常的发生情况，检验水准设定为p < 0.05。
**结果** 从11233项研究中，最终有38项符合纳入标准并被纳入本Meta分析。估算结果显示，左心室（Left Ventricular, LV）收缩功能障碍的发生率为25%（95%CI：19~31；I²=93%），整体纵向应变异常发生率为34%（95%CI：23~45；I²=90%），右心室（Right Ventricular, RV）收缩功能障碍发生率为17%（95%CI：13~21；I²=90%），心包积液发生率为17%（95%CI：9~26；I²=97%），肺动脉高压发生率为23%（95%CI：15~33；I²=96%）。左心室收缩功能障碍与研究中既往超声心动图异常的患病率呈直接相关（p<0.001）。反映疾病严重程度的机械通气患者占比，无法解释左心室功能障碍发生率的异质性（p=0.37）。
**结论** 在住院的新型冠状病毒肺炎患者中，约四分之一存在左心室功能障碍，右心室功能障碍、心包积液及肺动脉高压的发生率相对较低。但在纳入既往心脏病史的研究中，左心室功能障碍的发生率更高，提示此类心功能不全多为既往已存在的基础病变。