Incidence of Pulmonary and Cardiac Abnormalities on Point-of-Care Ultrasound in Adults With Post-acute COVID Syndrome: A Prospective Cohort Study

Study ObjectivesAfter recovery from acute infection with COVID-19, patients can suffer from a range of subacute to chronic symptoms, known as “post-acute COVID syndrome” (PACS). Point-of-care ultrasound (POCUS) is used extensively in patients presenting with acute COVID-19, especially focusing on the heart and lungs, but the utility of POCUS in PACS is not clear. Our study objective was to determine the incidence of cardiac and pulmonary abnormalities found with POCUS in patients presenting to a COVID-19 Recovery clinic which specializes in the evaluation of patients with PACS.MethodsWe conducted a prospective cohort study including adult (>18 years of age) patients presenting with cardiopulmonary symptoms to the COVID-19 Recovery Clinic at a tertiary care urban hospital.Ultrasounds were performed by one of five emergency physicians – four ultrasound faculty and one fellow within the last month of fellowship. A 12-zone lung ultrasound and a standard four-view bedside echocardiogram were performed. Images were interpreted in real-time by the performing sonographer and also independently interpreted by a blinded ultrasound faculty member. Any discrepancies in interpretation were addressed by a consensus of three of the ultrasound faculty members. A modified Soldati score was calculated based upon the sum of the scores in each of twelve lung zones, with normal lung receiving a score of 0 and dense white lung with/without consolidation receiving a score of 3. The maximum modified Soldati score was 36.Results/FindingsBetween April and July 2021, 41 patients received lung and cardiac POCUS examinations. Of those 41 patients, 24 patients were included in the study. The other 17 patients were excluded after chart review revealed no definitive prior COVID-19 testing with PCR or antibody testing. Fifteen out of 24 patients (62.5%) had a completely normal 12-zone lung ultrasound. Of the nine subjects with lung abnormalities, the median modified Soldati score was 2 (IQR 1-3, range 1-8). Three out of 24 patients had trivial pericardial effusions, and all had normal left and right ventricular size and function.ConclusionThe majority (62.5%) of patients presenting to a dedicated clinic for the care of post-acute COVID-19 have a normal pulmonary ultrasound, and the vast majority (87.5%) had a normal cardiac ultrasound, with trace/trivial pericardial fluid being the only cardiac abnormality found. This suggests that cardiopulmonary symptoms in PASC may have different etiologies than acute COVID-19.No, authors do not have interests to disclose Study ObjectivesAfter recovery from acute infection with COVID-19, patients can suffer from a range of subacute to chronic symptoms, known as “post-acute COVID syndrome” (PACS). Point-of-care ultrasound (POCUS) is used extensively in patients presenting with acute COVID-19, especially focusing on the heart and lungs, but the utility of POCUS in PACS is not clear. Our study objective was to determine the incidence of cardiac and pulmonary abnormalities found with POCUS in patients presenting to a COVID-19 Recovery clinic which specializes in the evaluation of patients with PACS. After recovery from acute infection with COVID-19, patients can suffer from a range of subacute to chronic symptoms, known as “post-acute COVID syndrome” (PACS). Point-of-care ultrasound (POCUS) is used extensively in patients presenting with acute COVID-19, especially focusing on the heart and lungs, but the utility of POCUS in PACS is not clear. Our study objective was to determine the incidence of cardiac and pulmonary abnormalities found with POCUS in patients presenting to a COVID-19 Recovery clinic which specializes in the evaluation of patients with PACS. MethodsWe conducted a prospective cohort study including adult (>18 years of age) patients presenting with cardiopulmonary symptoms to the COVID-19 Recovery Clinic at a tertiary care urban hospital.Ultrasounds were performed by one of five emergency physicians – four ultrasound faculty and one fellow within the last month of fellowship. A 12-zone lung ultrasound and a standard four-view bedside echocardiogram were performed. Images were interpreted in real-time by the performing sonographer and also independently interpreted by a blinded ultrasound faculty member. Any discrepancies in interpretation were addressed by a consensus of three of the ultrasound faculty members. A modified Soldati score was calculated based upon the sum of the scores in each of twelve lung zones, with normal lung receiving a score of 0 and dense white lung with/without consolidation receiving a score of 3. The maximum modified Soldati score was 36. We conducted a prospective cohort study including adult (>18 years of age) patients presenting with cardiopulmonary symptoms to the COVID-19 Recovery Clinic at a tertiary care urban hospital. Ultrasounds were performed by one of five emergency physicians – four ultrasound faculty and one fellow within the last month of fellowship. A 12-zone lung ultrasound and a standard four-view bedside echocardiogram were performed. Images were interpreted in real-time by the performing sonographer and also independently interpreted by a blinded ultrasound faculty member. Any discrepancies in interpretation were addressed by a consensus of three of the ultrasound faculty members. A modified Soldati score was calculated based upon the sum of the scores in each of twelve lung zones, with normal lung receiving a score of 0 and dense white lung with/without consolidation receiving a score of 3. The maximum modified Soldati score was 36. Results/FindingsBetween April and July 2021, 41 patients received lung and cardiac POCUS examinations. Of those 41 patients, 24 patients were included in the study. The other 17 patients were excluded after chart review revealed no definitive prior COVID-19 testing with PCR or antibody testing. Fifteen out of 24 patients (62.5%) had a completely normal 12-zone lung ultrasound. Of the nine subjects with lung abnormalities, the median modified Soldati score was 2 (IQR 1-3, range 1-8). Three out of 24 patients had trivial pericardial effusions, and all had normal left and right ventricular size and function. Between April and July 2021, 41 patients received lung and cardiac POCUS examinations. Of those 41 patients, 24 patients were included in the study. The other 17 patients were excluded after chart review revealed no definitive prior COVID-19 testing with PCR or antibody testing. Fifteen out of 24 patients (62.5%) had a completely normal 12-zone lung ultrasound. Of the nine subjects with lung abnormalities, the median modified Soldati score was 2 (IQR 1-3, range 1-8). Three out of 24 patients had trivial pericardial effusions, and all had normal left and right ventricular size and function. ConclusionThe majority (62.5%) of patients presenting to a dedicated clinic for the care of post-acute COVID-19 have a normal pulmonary ultrasound, and the vast majority (87.5%) had a normal cardiac ultrasound, with trace/trivial pericardial fluid being the only cardiac abnormality found. This suggests that cardiopulmonary symptoms in PASC may have different etiologies than acute COVID-19.No, authors do not have interests to disclose The majority (62.5%) of patients presenting to a dedicated clinic for the care of post-acute COVID-19 have a normal pulmonary ultrasound, and the vast majority (87.5%) had a normal cardiac ultrasound, with trace/trivial pericardial fluid being the only cardiac abnormality found. This suggests that cardiopulmonary symptoms in PASC may have different etiologies than acute COVID-19.