Abstract

Although coronavirus disease-2019 (COVID-19) primarily affects the respiratory system, it can also affect other systems. Cardiovascular effects in COVID-19 disease are common in hospitalized patients, and it has been shown that myocardial damage, pericarditis and pericardial effusion (PE) may develop. In our study, we aimed to evaluate the frequency and clinical significance of PE that may develop secondary to COVID-19 infection.

Thoracic computed tomography images of 989 consecutive COVID-19 patients, who remained after assessing the exclusion criteria, were evaluated. The presence of patients’ non-physiological PE was examined by a radiologist blinded to the study data. The patients were divided into two groups as those with and without PE. The presence of myocardial injury was defined according to hs-TnI levels (≥34 ng/dL).

PE was observed in 125 patients (12.6%). Sixty-three (50.4%) of the patients with PE were female, and there was no difference in terms of PE between the genders (p=0.315). The mean age of patients with PE was 72.8±14.3 years, while it was 64.8±14.9 years in patients without effusion (p<0.001). The frequency of myocardial injury was found to be higher in the group with PE (33.6% vs. 21.4%, p=0.023). In the group with PE (pulmonary embolism), the mortality rate was 36%, while it was 25% in the group without PE (p=0.009). In the group of patients who experienced mortality, age >65, male gender, hypertension, chronic obstructive pulmonary disease, chronic kidney failure, coronary artery disease, heart failure, atrial fibrillation, severe lung parenchymal involvement on CT, and presence of myocardial injury were observed at higher rates (all p-values <0.05).

The presence of PE in hospitalized COVID-19 patients may develop due to either a systemic inflammatory response or direct myocardial injury. Mortality was observed more frequently in this patient group. The presence of PE can be used as a mortality risk predictor in COVID-19 patents, so its routine evaluation in tomography is recommended.