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Echocardiogram Predicts Atrial Fibrillation in COVID-19 Patients

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Imaging test identifies patients most at risk for atrial fibrillation and atrial flutter.

A significant number of patients who have COVID-19 will go on to develop heart problems. Using echocardiography can help providers predict which individuals will go on to develop atrial fibrillation.

In a study published in the Journal of the American Society of Echocardiography, investigators from Johns Hopkins Medicine compared outcomes for patients who were COVID-19-positive with those who were not. All patients were treated for breathing problems in the hospital’s intensive care unit.

Alongside pinpointing which individuals are more likely to develop atrial fibrillation, the team determined those patients also had higher levels of the heart-related proteins troponin and NT-proBNP.

Research into patient outcomes from COVID-19 have revealed that patients who are hospitalized have more than double the rate of arrhythmias, such as atrial fibrillation and atrial flutter. These conditions can result in heart failure or stroke.

“[Our research] could lead to new therapies to prevent strokes and heart attacks in certain COVID-19 patients who are at the highest risk,” said senior author Allison Hays, M.D., medical director of the Johns Hopkins Hospital echocardiography program.

For their study, the team examined echocardiograms from 80 COVID-19-positive patients at 34 non-COVID-19 patient who were treated between March 2020 and June 2020. They used speckle-tracking strain to reveal how well the left atrium (the chamber of the heart that received oxygenated blood from the lungs) moved with each heartbeat.

Based on their analysis, they found the left atrium in COVID-19-positive patients did not work well. These individuals had much lower movement of the left atrium wall – 28.2 percent compared with 32.6 percent in non-COVID-19 patients. Patients positive for the virus also had a lower left atrial emptying fraction (the measure of how much blood is pumped out of the heart with each contraction) of 55.7 percent versus 64.1 percent.

Upon digging deeper, the team determined that COVID-19-positive patients who develop atrial fibrillation or flutter had 30-percent lower left atrial strain than did other patients hospitalized due to the virus – 22.3 percent versus 30.4 percent).

The team did pick up on some differences between blood samples from COVID-19-positive patients who developed atrial fibrillation and those who did not. Troponin levels and NT-proBNP levels (two known heart stress indicators) were higher in atrial fibrillation patients – 0.07 versus 0.03, and 946 versus 231, respectively.

“This tells us that COVID-19 patients with high levels of these biomarkers should be followed more closely and may benefit from an echocardiogram,” said first author Erin Goerlich, M.D., a Johns Hopkins cardiology fellow.

Although this study did not test whether treating patients positive for the virus could help side-step any complications that come from atrial fibrillation, it does point to the possibility of using blood thinners to treat patients with low left atrial strain as a possible option. But, more research is necessary, Hays said.

“We’re also actively studying how these effects on the heart might persist after SARVS-CoV-2 infection,” she said. “It’s important to known whether those measures of strain and emptying fraction improve over time.”

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