Prognostic impact of right ventricular dilatation and echocardiography use criteria in hospitalized COVID-19 patients

Table 4 Echocardiographic indications, appropriateness criteria, and clinical impact in confirmed coronavirus disease 2019 patients (n = 149)

Parameter	n (%)
Echocardiographic Indications (institutional algorithm)
Suspicion of heart failure	127 (85.2)
Elevated biomarkers with hemodynamic instability	38 (25.5)
Hemodynamic instability refractory to fluids/vasopressors	23 (15.4)
Myocardial infarction (universal definition)	19 (12.8)
Tachyarrhythmias (sinus or ventricular)	12 (8.1)
Cardiomegaly on imaging	9 (6.0)
No urgent indication	6 (4.0)
ASE 2020 clinical priority
High priority-change in cardiovascular symptoms	144 (96.6)
High priority-pre-therapy evaluation	3 (2.0)
Intermediate/low priority	2 (1.4)
ACCF 2011 appropriateness criteria
Appropriate	118 (79.2)
Inappropriate	27 (18.1)
Uncertain	4 (2.7)
Clinical impact of echocardiographic findings
Overall change in clinical management (impact)	120 (80.5)
Specific changes (within impact group)
Non-cardiac etiology identified	66 (55.0)
Cardiac primary etiology documented	47 (39.1)
Change in pharmacologic therapy	33 (27.5)
Request for additional diagnostic tests	21 (17.5)
Adjustment of vasopressors or inotropic agents	14 (11.6)
Consultation to other specialties	7 (5.8)
Adjustment in mechanical ventilation	4 (3.3)
No change in clinical management	29 (19.5)
Integration into clinical decision-making
Findings explicitly considered	124 (83.2)
Findings not considered in medical records	25 (16.8)

ACCF: American College of Cardiology Foundation; ASE: American Society of Echocardiography.