Echocardiographic Assessment of Cardiac Function in COVID-19 Patients

Transthoracic echocardiography has emerged as an indispensable tool for evaluating myocardial involvement in patients with COVID-19, offering real-time insights into biventricular performance, pulmonary haemodynamics and pericardial status. The non-invasive modality allows bedside monitoring of left ventricular systolic and diastolic function, right ventricular size and contractility, estimation of pulmonary artery pressures and detection of pericardial effusion. Echocardiographic parameters such as ejection fraction, global longitudinal strain and tricuspid annular plane systolic excursion have proven sensitive to subclinical ventricular impairment, guiding risk stratification and therapeutic decisions in both intensive care and general ward settings. By elucidating the interplay between respiratory mechanics and cardiac loading conditions, echocardiography has illuminated the mechanisms underpinning acute cardiac injury, right ventriculo-arterial uncoupling and pulmonary hypertension in severe COVID-19, with direct implications for ventilatory strategy, vasoactive support and long-term follow-up.

Research from Nature Portfolio

Recent meta-analytic work synthesised data from over 3,800 patients to demonstrate that right ventricular dysfunction occurs in approximately one in five hospitalised COVID-19 cases and confers a threefold increase in all-cause mortality. Heterogeneity across studies was noted, but severity of respiratory failure emerged as a key driver of right ventricular impairment. A complementary review of the pulmonary vascular sequelae of SARS-CoV-2 infection has highlighted the potential for evolution of chronic pulmonary hypertension, emphasising the role of serial echocardiographic surveillance in detecting progressive increases in pulmonary artery pressure and right ventricular remodelling following acute illness.

Echocardiographic Assessment of Cardiac Function in COVID-19 Patients publication trend

The graph below shows the total number of articles in echocardiographic assessment of cardiac function in covid-19 patients across all publications each year (not limited to Nature Index journals).

Technical terms

Transthoracic echocardiography: Ultrasound imaging of the heart via the chest wall to assess structure and function.

Left ventricular ejection fraction (LVEF): Percentage of blood ejected from the left ventricle with each heartbeat.

Global longitudinal strain (GLS): Measurement of myocardial deformation along the long axis, indicating systolic function.

Tricuspid annular plane systolic excursion (TAPSE): Distance travelled by the tricuspid valve plane, reflecting right ventricular systolic performance.

Pulmonary hypertension (PH): Elevation of pulmonary artery pressures, often estimated by echocardiography.

Right ventriculo-arterial coupling: Ratio of TAPSE to pulmonary artery systolic pressure, indicating efficiency of right ventricular output relative to afterload.

References

1. Comprehensive temporal analysis of right ventricular function and pulmonary haemodynamics in mechanically ventilated COVID-19 ARDS patients. Annals of Intensive Care (2024).
2. Global evaluation of echocardiography in patients with COVID-19. European Heart Journal - Cardiovascular Imaging (2020).
3. Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: a global perspective. Nature Reviews Cardiology (2021).
4. Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis. Scientific Reports (2021).
5. Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury. Infection (2021).