Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Case Report

Volume 11, Number 4, August 2020, pages 260-265

Echocardiographic Characteristics of Subjects With COVID-19: A Case Series

Figure 1. (a) Modified a4c view showing the tricuspid vegetation of case 3. (b) Peak GLS showing decreased values in the inferolateral and inferoseptal territories of case 4. a4C: apical four-chamber view; GLS: global longitudinal strain.

**Table 1.** Baseline Clinical and Laboratory Characteristics
Variable	Case 1	Case 2	Case 3	Case 4
hs-CRP: high-sensitivity C-reactive protein; ARDS: acute respiratory distress syndrome; hs-TpnI: high-sensitivity troponin I; CK: creatine kinase; CK-MB: creatine kinase myocardial band; LDH: lactate dehydrogenase.
Gender	Male	Male	Male	Male
Age (years)	76	64	66	26
Comorbidities	Prostate cancer	HIV	None	None
White blood cell count, /µL	11.2	8.6	14.3	8.1
Lymphocytes, /µL	0.306	0.483	0.563	1.4
Serum creatinine, mg/dL	0.9	0.9	5.3	0.8
Aminotransferase
Aspartate, U/L	44	96	99	68
Alanine, U/L	40	108	43	85
Albumin, g/dL	2.1	2	2.7	3.4
hs-CRP, mg/dL	27	20.6	23.1	11.3
ARDS	Yes	Yes	Yes	Yes
PaO₂/FiO₂ ratio	59	66	180	258
Cardiac injury markers
hs-TpnI, ng/L	2.8	5.4	5.6	1.4
CK, U/L	721	868	517	50
CK-MB, U/L	29	35.3	26.5	n/a
LDH, U/L	312	259	424	317

Table 1. Baseline Clinical and Laboratory Characteristics

Variable

Case 1

Case 2

Case 3

Case 4

hs-CRP: high-sensitivity C-reactive protein; ARDS: acute respiratory distress syndrome; hs-TpnI: high-sensitivity troponin I; CK: creatine kinase; CK-MB: creatine kinase myocardial band; LDH: lactate dehydrogenase.

Gender

Male

Age (years)

Comorbidities

Prostate cancer

HIV

None

White blood cell count, /µL

11.2

8.6

14.3

8.1

Lymphocytes, /µL

0.306

0.483

0.563

1.4

Serum creatinine, mg/dL

0.9

5.3

0.8

Aminotransferase

Aspartate, U/L

Alanine, U/L

108

Albumin, g/dL

2.1

2.7

3.4

hs-CRP, mg/dL

20.6

23.1

11.3

ARDS

Yes

PaO₂/FiO₂ ratio

180

258

Cardiac injury markers

hs-TpnI, ng/L

2.8

5.4

5.6

1.4

CK, U/L

721

868

517

CK-MB, U/L

35.3

26.5

n/a

LDH, U/L

312

259

424

317

**Table 2.** Echocardiographic characteristics and Recommended Reference Values
Variable	Case 1	Case 2	Case 3	Case 4	Reference value
Data are shown as frequencies (%) and median (min. - max.) or mean ± SD. LV: left ventricular; LVEF: LV ejection fraction; GLS: global longitudinal strain; a4C: apical four-chamber view; APLAX: apical long axis view; a2C: apical two-chamber view; TAPSE: tricuspid annulus plane systolic excursion; RV: right ventricular; MV: mitral valve; n/a: not available.
LV septal thickness, cm	0.8	1.2	1.1	0.7	0.6 - 1
Posterior wall thickness, cm	0.8	1.1	0.8	0.9	0.6 - 1
LV indexed mass, g/m²	80.7	56.5	81.4	73.6	49 - 115
Relative wall thickness	0.31	0.47	0.32	0.37	0.24 - 0.42
VfdVI MOD BP	38	76	n/a	83	62 - 150
VfsVI MOD BP	25	26	n/a	56	21 - 61
LVEF, %	35	66	65	33	52 - 72
Left atrial indexed volume, mL/m²	21.8	15.4		11.1	< 34
Average GLS, %	-14	-18	n/a	-14	< -18.5%
Aplax GLS, %	-12	-18	n/a	-14	< -18.5%
a4C GLS, %	-13	-18	n/a	-13	< -18.5%
a2C GLS, %	-15	-19	n/a	-14	< -18.5%
TAPSE, mm	25	26	20	20	> 18
S wave, cm/s	0.18	0.7	0.18	0.12	> 0.095
RV basal diameter, mm	33	34	47	39	25 - 41
RV mid-cavity diameter, mm	29	22	45	34	19 - 35
MV E wave velocity, m/s	0.5	0.83	0.54	0.38	> 50
MV deceleration time, ms	210	218	185	147	> 200
E/A ratio	0.63	1.03	0.69	0.44	≥ 0.8
Septal e′ velocity, m/s	0.05	0.08	0.07	0.1	> 7
Lateral e′ velocity, m/s	0.1	0.09	0.1	0.1	> 10
E/e′ ratio	6.6	9.66	6.27	3.78	< 10

Table 2. Echocardiographic characteristics and Recommended Reference Values

Variable

Case 1

Case 2

Case 3

Case 4

Reference value

Data are shown as frequencies (%) and median (min. - max.) or mean ± SD. LV: left ventricular; LVEF: LV ejection fraction; GLS: global longitudinal strain; a4C: apical four-chamber view; APLAX: apical long axis view; a2C: apical two-chamber view; TAPSE: tricuspid annulus plane systolic excursion; RV: right ventricular; MV: mitral valve; n/a: not available.

LV septal thickness, cm

0.8

1.2

1.1

0.7

0.6 - 1

Posterior wall thickness, cm

0.8

1.1

0.8

0.9

0.6 - 1

LV indexed mass, g/m²

80.7

56.5

81.4

73.6

49 - 115

Relative wall thickness

0.31

0.47

0.32

0.37

0.24 - 0.42

VfdVI MOD BP

n/a

62 - 150

VfsVI MOD BP

n/a

21 - 61

LVEF, %

52 - 72

Left atrial indexed volume, mL/m²

21.8

15.4

11.1

< 34

Average GLS, %

-14

-18

n/a

-14

< -18.5%

Aplax GLS, %

-12

-18

n/a

-14

< -18.5%

a4C GLS, %

-13

-18

n/a

-13

< -18.5%

a2C GLS, %

-15

-19

n/a

-14

< -18.5%

TAPSE, mm

> 18

S wave, cm/s

0.18

0.7

0.18

0.12

> 0.095

RV basal diameter, mm

25 - 41

RV mid-cavity diameter, mm

19 - 35

MV E wave velocity, m/s

0.5

0.83

0.54

0.38

> 50

MV deceleration time, ms

210

218

185

147

> 200

E/A ratio

0.63

1.03

0.69

0.44

≥ 0.8

Septal e′ velocity, m/s

0.05

0.08

0.07

0.1

> 7

Lateral e′ velocity, m/s

0.1

0.09

0.1

> 10

E/e′ ratio

6.6

9.66

6.27

3.78

< 10