Impact of Focused Echocardiography on Scan Time and Diagnostic Quality in Patients with COVID-19.

To the Editor:

Severe acute respiratory syndrome coronavirus-2 infection and the resulting illness, coronavirus disease 2019 (COVID-19), have been characterized by widespread transmission of the virus leading to high morbidity and mortality. , Cardiovascular imaging societies have recommended major changes to the way imaging is performed, , with a focus on appropriateness and the use of abbreviated protocols (focused or limited scans) with the aim of shortening scan time to reduce contact between sonographers and patients, thereby lowering the risk for virus transmission. There are limited data on the impact of these guideline recommendations on contact time between sonographers and patients and the resulting reproducibility and accuracy of these studies.

We identified all patients with proven (polymerase chain reaction swab positive) or suspected COVID-19 who underwent echocardiography between March 23, 2020, and April 24, 2020. This study was approved by the institution's clinical effectiveness office. Study acquisition time, number of images obtained, and adherence to minimum data set protocol were obtained. Study acquisition time was defined as time from first to last image. The time for measurements and reporting was not included, as these are performed away from the patient. All studies were reviewed by an independent reviewer, blinded to the examination period, to examine the interobserver variability of left ventricular and right ventricular systolic function. The clinical notes were reviewed for the week after the echocardiographic examination to identify any alternative data (invasive or clinical) or repeat imaging that refuted the echocardiography report. We included a control group of 50 patients who underwent inpatient echocardiography before the COVID-19 pandemic.

One hundred seventy-one patients with proven or suspected COVID-19, with a median age of 59 years, underwent echocardiography during the study period. The median scan time was 6 min (interquartile range [IQR], 4–8 min). This was significantly reduced compared with the control group (median, 14.5 min; IQR, 10–16 min; P < .0001). The number of images obtained was significantly fewer (25 images; IQR, 17–36 images) than in the control group (55 images; IQR, 39–66; P < .0001). There was no difference in the proportion of studies that met the minimum data set (158 of 171 [92.4%] vs 47/50 [94%], P = .99). There was no difference in the proportion of patients with exact agreement for interobserver assessment of left ventricular function (162 of 171 [94.7%] and 49 of 50 [98%], P = .46). There was no difference in the proportion of cases with exact agreement of right ventricular function (160 of 171 [94.1%] and 48 of 50 [96%], P = .74). Alternative or repeat imaging refuting the report of the initial echocardiographic examination occurred in one of 171 cases (0.58%) and zero of 50 cases (0%) in the control group (P = .99).

Implementation of focused or limited scans during the COVID-19 pandemic significantly reduced scan time and exposure of sonographers by more than 50%. This confirms the findings of McMahon et al. and additionally shows that despite the reduction in acquisition time, quality was good, with a high adherence to protocols, a low degree of interobserver variability, and almost no refuted reports. There is a lack of evidence and uncertainty regarding the risk of COVID-19 to health care workers. Mitigation of potential risk by reducing exposure time is advisable. We have demonstrated that exposure time can be reduced while maintaining quality and benefit of the test to patients.