# Prognostic value of echocardiogram and cardiac biomarkers through three waves of COVID-19

## TL;DR

This study examines how different waves of the COVID-19 pandemic affected heart function and survival using echocardiograms and biomarkers.

## Contribution

The study identifies distinct cardiac impacts and survival correlations across three major waves of SARS-CoV-2 variants.

## Key findings

- The Original wave showed the highest ICU admission rate and BNP levels with significant left ventricular diastolic dysfunction.
- Delta wave patients had the highest troponin levels and specific echocardiographic parameters correlated with survival.
- Omicron wave patients had lower left atrial volume but higher tricuspid annular systolic excursion compared to earlier waves.

## Abstract

COVID-19 has had a significant impact on the scientific field. The multitude of effects this virus has on different organ systems is a continuously expanding range of study. The purpose of this study is to differentiate between the cardiac effects of the three different waves of COVID identified between March 2020- July 2022 using echocardiographic results and the cardiac biomarkers troponin and B-type natriuretic peptide (BNP). By using this information, we can evaluate cardiac impact from COVID-19, which may lead to effects on overall survival.

Information was gathered through eight acute care facilities as part of a multi-center retrospective observational cohort study of patients hospitalized with confirmed SARS-CoV-2, who experienced a cardiovascular event and received an echocardiogram during admission between March 2020 and July 2022. A total of 222 participants were included and divided into 3 waves based on the highest SARS-CoV-2 strain prevalence at the time in Louisville, KY, USA. This consisted of 56 patients in the Original wave 1 (March–July 2020), 143 during the Delta wave 2 (September 2020–March 2021), and 23 during the Omicron wave 3 (January 2022-July 2022).

There were statistically significant differences in cardiac functions as indicated by echocardiogram and cardiac biomarkers. The Original wave not only showed the highest intensive care unit (ICU) admission rate of 73.2 %, but it also had a notable left ventricular diastolic dysfunction and the highest BNP levels. The Delta wave had the highest troponin value of 3.1 ng/mL. The left atrial volume of patients in the Omicron wave was significantly lower than in the Original and Delta waves. However, the tricuspid annular place systolic excursion for patients in the Omicron wave was significantly higher than the other two waves. In survival time models correlated with echocardiograph parameters, the Original wave showed significant correlations between left ventricular ejection fraction, left ventricular volume, right ventricular diameter, and survival. Delta wave showed significant correlation between ascending aortic size, right ventricular systolic pressure, right atrial pressure, and survival. the Omicron wave displayed significant correlation between peak troponin levels and survival.

COVID-19 variants showed statistically significant impacts on cardiac function and biomarkers. There were significant correaltions between these echocardiographic parameters and biomarkers with survival. These cardiac differences can be used to determine overall severity of disease and provide insight into the level of clinical care indicated in COVID patients.