PREDICTIVE VALUE OF LUNG AND MYOCARDIAL PERFUSION IMAGING IN ACUTE COVID-19 INFECTION

Background: Acute COVID-19 infection is associated with a wide variety of pro-inflammatory and pro-thrombotic responses that may affect myocardial and lung function, leading to defective hypoxic pulmonary vasoconstriction (HPV) and microvascular perfusion (MVP) abnormalities. The purpose of this study was to determine what role abnormal MVP or abnormal lung perfusion (LP), measured with bedside contrast ultrasound, have on predicting patient outcome in acute in house COVID-19 infection. Methods: 140 consecutive patients with acute COVID-19 infection requiring hospital admission underwent lung and cardiac ultrasound before and after intravenous ultrasound contrast injections. MVP, LP, left ventricular (LV) systolic and diastolic function, pulmonary artery systolic pressure (PASP), standard lung US, and relevant clinical variables were compared to examine their ability to predict in house and one year mortality. Abnormal lung perfusion (LP) was defined as contrast replenishment following high mechanical index impulses within small intrapulmonary arteries in zones of consolidation. Mortality was modeled by Cox regression with predictors age, known heart disease, diabetes, body mass index, LV ejection fraction, PASP, diastolic function, presence of B-lines on lung ultrasound, MVP, and LP, to estimate hazard ratios (HRs) and 95% Confidence Intervals (CIs). Results: Abnormal resting MVP was seen in 33 patients (31%). with 12 exhibiting transmural defects (36%). Abnormal LP was seen in 30 patients