Moreover, left atrial strain was even lower among the 30% of patients with COVID-19 who developed atrial fibrillation or flutter during their hospital stay compared with other patients with COVID-19 (22.3% compared to 30.4%, p<0.001). This suggests that speckle-tracking analysis — and specifically, left atrial strain measurement — could be used to predict which patients with COVID-19 are at highest risk of arrhythmias and develop preventive treatments.
“A lot of patients already get echocardiograms while in the hospital; the addition of strain analysis requires no extra scanning of the patient,” says Erin Goerlich, M.D., a cardiology fellow at the Johns Hopkins University School of Medicine and first author of the new paper. “So this is a safe and affordable new data point that can clue us in about who might develop atrial fibrillation.” Echocardiograms cost on average about $2,000, and are generally covered by health insurance.
When the researchers looked at the blood of patients with COVID-19 who developed atrial fibrillation, they saw some differences compared with other patients with COVID-19. People who developed atrial fibrillation had higher levels of troponin (0.07 versus 0.03, p=0.011) and NT-proBNP (946 versus 231, p=0.0007), two known markers of heart stress.
“This tells us that COVID-19 patients with high levels of these biomarkers should be followed more closely and may benefit from an echocardiogram,” says Goerlich.
Hays cautioned that the current study didn’t test whether treating patients with COVID-19 with blood thinners could help prevent the complications that can result from atrial fibrillation, which has been suggested by some clinicians. Blood thinners are generally prescribed to atrial fibrillation patients to lower the risk of blood clots and strokes.
However, the new study suggests that treating certain people — those with especially low left atrial strain, for instance — could be one path forward. More research is needed in this area, Hays says.
“We’re also actively studying how these effects on the heart might persist after SARS-CoV-2 infection,” she adds. “It’s important to know whether those measures of strain and emptying fraction improve over time.”
In addition to Allison Hays and Erin Goerlich, other authors on the JASE paper are Anum Minhas, Nisha Gilotra, Andreas Barth, Monica Mukherjee, Allyso Parziale and Katherine Wu of the Johns Hopkins University School of Medicine.
The research was supported by a Ruth L. Kirschstein Institutional National Research Service Award (T32HL007227); the National Heart, Lung, and Blood Institute (T32HL007024 and 1R01HL147660); the Magic That Matters Fund of Johns Hopkins Medicine; and a Johns Hopkins Clinician Scientist Award.
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