Written by : Dyna Evalina Syahlul, MD, FIHA
Due to the cardiac complications of COVID-19, echocardiography will likely be required for patients with suspected or confirmed COVID-19.1 Trans-thoracic echocardiography (TTE), stress echocardiography and trans-esophageal echocardiography (TEE) should only be performed if the result has an important impact on the patient management.1,2,3
All patients undergoing echocardiography examination should be screened for: symptoms (cough, runny nose, fever and shortness of breath); any previous diagnostic work-up for COVID-19; history of exposure to COVID-19 patients; and checked for body temperature.2 For confirmed or suspected COVID-19 patients, the elective echocardiography examination should be deferred. Then, the suspected COVID-19 patient should be reported to the Prevention and Control of Infection Division or the COVID-19 Working Group in the hospital.2 In deferred cases, there should be no significant risk to patients in terms of morbidity or mortality.1
The indications for echocardiography examination in suspected COVID-19 patients are urgent and emergent cases in which the examination determines the treatment and life-saving; hypotension; shock ; hypoxia; chest pain with suspected aortic dissection or myocardial infection; infective endocarditis and prosthetic valve malfunction. The examination of above cases should be a focused cardiac ultrasound study and based on clinical judgement. The echocardiography examination should follow below protocols: minimal contact with the patient, echocardiography measurement done after the examination and follow the standard Personal Protective Equipment in the hospital.2 The echocardiography examination for non-suspected COVID-19 patients should follow the Personal Protective Equipment.2 In this group of patients, elective echocardiography examination should be deferred.1,2
Due to the risk of viral aerosolization during TEE examination, special consideration should be taken before performing it. A special consideration of the benefit of a TEE examination in confirmed or suspected COVID-19 should be weighed against the risk of exposure of healthcare personnel to aerosolization. TEEs should be deferred if an alternative imaging modality (e.g. off axis TTE views, ultrasound enhancing agent with TTE, computed tomography (CT) and magnetic resonance imaging (MRI)). Similarly, treadmill or bicycle stress echocardiography examination in confirmed or suspected COVID-19 patients may cause exposure due to deep breathing and/or coughing during exercise. These tests should generally be deferred or converted to a pharmacological stress echocardiography.1
Dyna Evalina Syahlul, MD, FIHA works as cardiologist at RSPAD Gatot Soebroto – Presidential Hospital.
1. Kirkpatrick, J. N. Mitchell, C. Taub, C. Kort, S. Hung, J. Swaminathan, M. 2020. ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak. [Online]. American Society of Echocardiography. Available: https://www.asecho.org/ase-statement-covid-19/#references [Accessed April 17th 2020].
2. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Protokol Tindakan Ekokardiografi Transtorakal / Transesofageal dalam konteks kewaspadaan Infeksi Covid-19. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. [Online]. Available: http://www.inaheart.org/perki/upload/files/ [Accessed April 17th 2020].
3. Skulstad, H., Cosyns, B., Popescu, B. A., Galderisi, M., Salvo, G. D., Donal, E., Petersen, S., Gimelli, A., Haugaa, K. H., Muraru, D., Almeida, A. G., Schulz-Menger, J., Dweck, M. R., Pontone, G., Sade, L. E., Gerber, B., Maurovich-Horvat, P., Bharuca, T., Cameli, M., Magne, J., Westwood, M., Maurer, G. & Edvardsen, T. COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. Eur Heart J Cardiovasc Imaging. 2020;0: 1-7.