Memo and Funds Request
Echocardiography is essential in the detection and monitoring of
cardiovascular disease related to COVID-19 infection
Angel Pine Community Hospital’s Diagnostic Imaging department seeks to purchase a dedicated cardiovascular ultrasound system in order to provide premier care to patients diagnosed with the novel coronavirus. Evolving research on both the acute and long-term effects of the novel coronavirus (SARS-CoV-2) has shown that the attack on angiotensin-converting enzyme 2 (ACE-2) by the virus causes a cascade of cardiovascular and immunologic sequelae in infected patients.1,2 Additionally, many symptoms of infection (shortness of breath, cough, hypoxia, chest discomfort, and fatigue) are non-specific, and may lead clinicians to pursue diagnostic imaging exams (including echocardiography) to assess for the presence of cardiac pathology. The use of echocardiography has already proven useful in the treatment of COVID-19 related pneumonia and associated circulatory failure.3 Many patients infected with coronavirus will go on to develop chronic myocarditis, requiring further monitoring well past resolution of symptoms.4 Echocardiography plays an important role in the detection and monitoring of cardiovascular pathologies relating to coronavirus infection; during this pandemic, and in the time to follow, we aim to provide premiere care to those affected by this virus.
The novel coronavirus targets the cardiovascular system by binding to the angiotensin-converting enzyme 2 (ACE-2) concentrated within the coronary arteries, vascular epithelium, and pulmonary alveolar epithelial cells. It is by this mechanism that we see a wide range of cardiovascular side effects, ranging in severity. Cardiac pathologies seen with coronavirus infection include myocarditis, Takutsubo cardiomyopathy, acute coronary syndrome, right heart failure, pericarditis, arrhythmias, and exacerbation of pre-existing disease and dysfunction.4,5 Abnormal perfusion and pneumonia secondary to coronavirus infection have also been shown to adversely affect the right heart system.6 The assessment of both underlying and newly acquired heart dysfunction is critical in the development of treatment plans for patients affected by moderate-severe infections. Specifically relating to myocarditis and right heart dysfunction, strain and speckle tracking have been shown to provide accurate and reproducible measurements of global longitudinal strain, allowing providers to monitor and diagnose patients effectively.7
Angel Pine Community Hospital’s Diagnostic Imaging department seeks $50,000 to purchase a dedicated cardiac ultrasound system in order to provide premier care to the patients in our community diagnosed with coronavirus. The current system used for cardiac imaging is limited in its ability to evaluate cardiac pathologies due to its technical specifications. Purchasing a dedicated echocardiography system would allow for more complete evaluation of cardiac pathologies due to enhanced image quality, improved temporal, axial, and color resolutions, and myocardial strain/ speckle tracking technology (essential for long-term monitoring left ventricle global longitudinal strain in the assessment of myocarditis). Specifically, having the capability to perform strain and speckle tracking would greatly enhance our ability to determine myocardial dysfunction resulting from inflammation and pulmonary issues.
*Hospital name changed.
References:
1. CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. Published February 11, 2020. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Flong-term-effects.html
2. Can Coronavirus Cause Heart Damage? www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/can-coronavirus-cause-heart-damage
3. Peng Q-Y, Wang X-T, Zhang L-N. Using echocardiography to guide the treatment of novel coronavirus pneumonia. Critical Care. 2020;24(1). doi:10.1186/s13054-020-02856-z
4. Satterfield BA, Bhatt DL, Gersh BJ. Cardiac involvement in the long-term implications of COVID-19. Nature Reviews Cardiology. Published online October 22, 2021. doi:10.1038/s41569-021-00631-3
5. Giustino G, Croft LB, Oates CP, et al. Takotsubo Cardiomyopathy in COVID-19. Journal of the American College of Cardiology. 2020;76(5):628-629. doi:10.1016/j.jacc.2020.05.068
6. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiology. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1286
7. Uziębło-Życzkowska B, Mielniczuk M, Ryczek R, Krzesiński P. Myocarditis successfully diagnosed and controlled with speckle tracking echocardiography. Cardiovascular Ultrasound. 2020;18:19. doi:10.1186/s12947-020-00203-4