Echocardiographic phenomenon of pericarditis in patients with severe COVID-19 pneumonia. One-year observation
Authors: Sukmarova Z , Saidova MA 
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction. As seen in practice, such an ultrasound (us) phenomenon as the inflammation of the pericardium caused by COVID-19 is underestimated due to a very tough time pressure in the infection unit, minor effusion and the incorrect interpretation of cardialgia. The study is intended to evaluate the frequency of cases when the pericardium is involved in the COVID- syndrom, describe us-changes and dynamics throughout the year. Methods. We performed TTEchocardiography of pts during the first days of their admission to COVID-centre with pneumonia CT3-4 and during the year following their discharge, once in 4 months. The study was conducted by one observer, one equipment with same brightness settings. Results. 158 of 720 pts returned for a follow-up. 36 pts excluded due to the recurring infection, and 47 ones got vaccinated. Analyzed 75 cases. In the acute phase of infection, circumferential effusion was found in 98% of pts (the max pericardial layer separation by 4[3-6] mm). 2%pts has a thick layer of epicardial fat, which could possibly hide the minor hydropericardium. Furthermore, we captured a moderate increase in the echogenity of pericardium, especially in the inferolateral segments, multiple artifacts like B-lines stretching from pericardium line to the lungs in the basal ventricular segments left and right and around the atria. On 4 months after infection pericardial layer separation by≥3mm was detected in 8% pts (in persisting cases, effusion was 5[3-9] mm). Only the half of the pts had heart failure. The group without effusion demonstrated hyperechogenity of pericardium in the left basal segments, and both atria along perimeter of the free walls, confluent artifacts like the comet tail and the waterfall. In 8 months pericarditis with effusion persevered in 2 pts, with the max pericardial layer separation 5 and 3mm and vertical confluent artifacts. On the other pts, the hyperechogenic area of the pericardium reduced down to the basal inferolateral segments of left ventricle, base of the left atrium in 82% and the base of the right atrium in 18%. In 12 months, 1 pt had the recurring pericarditis, notwithstanding the therapy. The minimum hyperechogenity in the basal inferolateral segments of the left ventricle persisted in 61% of pts. The number of separate, narrow vertical artifacts was not different from the pts without COVID-19 (1-4 per view). 

Conclusions

Perhaps, the pericardium is a target organ for COVID-19, since it is involved in the acute phase of pneumonia in 98% of cases. Us-signs of the pericarditis persevere throughout many months after the pt’s discharge. Even the minor hydropericardium should be observed, since the clinic may deteriorate in 85% of cases in 4 months after the infection even in those pts who have no heart failure. Pericarditis, as an us-phenomenon, demonstrates the predictable dynamics of visual changes throughout the year. To interpret the changes, vertical artifacts of the pericardium should be evaluated. Abstract Figure. 56yo, acute COVID-CT3, effusion, bright  Abstract Figure. same pt, 3mo after:effusion, comet-tale