Johns Hopkins Medicine researchers have shown that a type of echocardiogram may be useful in predicting which patients with COVID-19 are most at risk of developing an irregular heartbeat called atrial fibrillation. The research also suggests that patients with COVID-19 who develop atrial fibrillation commonly have elevated levels of two heart stress markers in their blood test samples.

Previous studies found that patients hospitalized with COVID-19 have more than double the normal rate of arrhythmias, including atrial fibrillation and atrial flutter (a similar rapid heart rhythm). But exactly how the virus causes these heart complications, and who is most at risk of developing them because of COVID-19, has been poorly understood.

In the Johns Hopkins study, Allison Hays —medical director of echocardiography programs at The Johns Hopkins Hospital and senior author of the published paper about the research — and colleagues compared patients who had COVID-19 with patients who did not have the disease. All of the patients were treated for respiratory issues at The Johns Hopkins Hospital, in the intensive or intermediate care units. None had a history of heart arrhythmia.

The researchers analyzed echocardiograms of hospitalized patients, applying speckle-tracking analysis to determine how well the heart’s left atrium moved with each heartbeat.

The team found that, overall, patients with COVID-19 had reduced function of their left atrium. Left atrial strain a measure of the movement of the left atrium’s walls — was significantly lower in patients with COVID-19. Left atrial emptying fraction — a measure of how much blood the atrium empties with each contraction — was also lower in the patients with COVID-19.

Left atrial strain was even lower among the patients with COVID-19 who developed atrial fibrillation or flutter during their hospital stay compared with other patients who had COVID-19. This suggests that speckle-tracking analysis specifically, left atrial strain measurement — could be used to predict which patients with COVID-19 are at highest risk of arrhythmias.

When the researchers looked at the blood of patients with COVID-19 who developed atrial fibrillation, they saw some differences compared with other patients who had COVID-19. People who developed atrial fibrillation had higher levels of troponin and N-terminal pro-brain natriuretic peptide — two markers of heart stress.

Hays says the study suggests that treating certain patients — those with especially low left atrial strain, for example — could be one path forward, but more research is needed.

See the entire news release: Imaging Test May Predict Patients Most at Risk of Some Heart Complications from COVID-19.