ABC | Volume 115, Nº1, July 2020

Review Article Cardiovascular Imaging and Interventional Procedures in Patients with Novel Coronavirus Infection Isabela Bispo Santos da Silva Costa, 1 Carlos Eduardo Rochitte, 2,3, 4 C arlos M. Campos, 5,6 Silvio Henrique Barberato, 7, 8 G láucia Maria Moraes de Oliveira, 9 Marcelo Antônio Cartaxo Queiroga Lopes, 10,11,12 Cesar Higa Nomura, 2 Alexandre A. Abizaid, 2,13 Giovanni Cerri, 2 Roberto Kalil Filho, 2 Ludhmila Abrahão Hajjar 1, 2 Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, 1 São Paulo, SP - Brazil Universidade de São Paulo Instituto do Coração, 2 São Paulo, SP - Brazil Hospital do Coração, 3 São Paulo, SP - Brazil Hospital Pró-Cardíaco, 4 Rio de Janeiro, RJ - Brazil Universidade de São Paulo Instituto do Coração - Hemodinâmica e Cardiologia Intervencionista, 5 São Paulo, SP - Brazil Hospital Israelita Albert Einstein - Hemodinâmica e Cardiologia Intervencionista, 6 São Paulo, SP - Brazil CardioEco -Centro de Diagnóstico Cardiovascular, 7 Curitiba, PR - Brazil Quanta Diagnóstico – Ecocardiografia, 8 Curitiba, PR - Brazil Universidade Federal do Rio de Janeiro – Cardiologia, 9 Rio de Janeiro, RJ - Brasil Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, 10 João Pessoa, PB - Brazil Hospital Metropolitano Dom José Maria Pires, 11 João Pessoa, PB - Brazil Sociedade Brasileira de Cardiologia, 12 Rio de Janeiro, RJ - Brazil Hospital Sírio Libanês, 13 São Paulo, SP - Brazil Abstract The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures. 1. Introduction Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a huge challenge worldwide. The rapid spread of the infection has grown into a global level pandemic. As by May 20th, COVID-19 had already reached 185 countries, with 4,995,127infected individuals and 160,706 deaths. 1 Despite underreporting due to test unavailability, Brazilian statistics have shown increasing numbers, with 291,579 infected patients and 18,859 deaths registered to date. 2 The most effective strategy to control COVID-19 spread is home confinement, via quarantine and social distancing. 3 Hospitals, clinics and medical offices have been following the recommendations of national and international medical societies to protect patients without COVID-19 from the risk of infection, while, at the same time, providing adequate care to those with COVID-19. 4,5 In light of this, procedures considered elective should be timely rescheduled. 6 The proper management of infected patients requires the adoption of a series of measures involving the interaction of several hospital sectors and the training of multidisciplinary teams. The majority of patients with the most severe COVID-19 forms have comorbidities, cardiovascular diseases being frequent. 7-9 In addition, cardiovascular complications of COVID-19 occur in 7% to 40% of the cases, manifesting as myocardial injury, thrombosis, ventricular dysfunction, myocarditis, arrhythmias, and shock. 10-12 These complications have significant prognostic implications, such as a high mortality rate. 11 The diagnosis and follow-up of patients with those complications usually require performing imaging tests, such as electrocardiography, transthoracic echocardiography (TTE), computed tomography (CT), in addition to cardiac magnetic resonance imaging (CMRI) and coronary computed tomography angiography (CCTA). These tests should not be performed routinely in all infected patients, their indication being preferably based on the benefit added to the patient’s care and considering the safety of the staff conducting the tests. The need for rational, responsible, and thorough use of resources reinforces the importance of the clinician not only in identifying patients who need the test, but also in selecting the proper tests and in accurately interpreting their findings. This review was aimed at: a) helping physicians to properly indicate and implement cardiovascular tests and interventional procedures in their clinical practice for patients with suspected Keywords Coronavirus; COVID-19; Pandemics; Communicable Diseases, Emergency; Cardiovascular Diseases/prevention and control; Diagnostic Imaging; Medical Examination/methods; Diagnostic Techniques and Procedures. Mailing Address: Isabela Bispo Santos da Silva Costa • Universidade de São Paulo Instituto do Câncer do Estado de São Paulo – Av. Dr. Arnaldo, 251. Postal Code 01246-000, São Paulo, SP – Brazil E-mail: Isabela.bispo@hc.fm.usp.br Manuscript received April 28, 2020, revised manuscript April 29, 2020, accepted April 29, 2020 DOI: https://doi.org/10.36660/abc.20200370 111