Although cardiac involvement has prognostic significance in COVID-19 and is associated with severe presentations, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19.

Consecutive patients with COVID-19 admitted in 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed-up for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization.

Among 2878 patients, 445 (15%) underwent TTE. Most had cardiovascular risk factors, a history of cardiovascular disease, and were under cardiovascular medications. Dilatation and dysfunction were observed in12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV), respectively. Primary composite outcome occurred in 44% (n=196) of patients (9% [n=42] for death without ICU transfer and 35% [n=154] for admission to ICU). RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex (hazard ratio [HR] 1.56, 95% CI 1.09−2.25; P=0.02), higher body mass index (HR 1.10, 95% CI 1.02−1.18; P=0.01), anticoagulation (HR 0.53, 95% CI 0.33−0.86; P=0.01), and RV dilatation (HR 1.66, 95% CI 1.05−2.64; P=0.03) remained independently associated with the primary outcome (Figure 1).

Echocardiographic evaluation of RV dilatation could be useful for assessing the risk of inhospital death or transfer to ICU in severe hospitalized COVID-19 patients.