Cardiac manifestations in critically ill patients with COVID-19: do we really know what hit us?

Hjortrup, Peter Buhl; Butt, Warwick

doi:10.1007/s00134-022-06727-9

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…To possibly prevent later mortality, we agree with a recent Editorial comment 18 that ICU‐treated Covid‐19 aPH patients should benefit from close follow‐up, under the auspice of a cardiologist or physician with a similar competency, for at least 1 year after the initial hospitalization. This may apply to any ICU patient, regardless of etiology, that is diagnosed with aPH during their ICU stay.…”

Section: Discussionsupporting

confidence: 53%

Severe Covid‐19 and acute pulmonary hypertension: 24‐month follow‐up regarding mortality and relationship to initial echocardiographic findings and biomarkers

Norderfeldt

Liliequist

Eksborg

et al. 2022

Acta Anaesthesiol Scand

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Introduction Critically ill Covid‐19 patients are likely to develop the sequence of acute pulmonary hypertension (aPH), right ventricular strain, and eventually right ventricular failure due to currently known pathophysiology (endothelial inflammation plus thrombo‐embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. Furthermore, an in‐hospital trans‐thoracic echocardiography (TTE) diagnosis of aPH is associated with a substantially increased risk of early mortality. The aim of this retrospective observational follow‐up study was to explore the mortality during the 1–24‐month period following the TTE diagnosis of aPH in the intensive care unit (ICU). Methods A previously reported cohort of 67 ICU‐treated Covid‐19 patients underwent an electronic medical chart‐based follow‐up 24 months after the ICU TTE. Apart from the influence of aPH versus non‐aPH on mortality, several TTE parameters were analyzed by the Kaplan–Meier survival plot technique (K‐M). The influence of biomarkers for heart failure (NTproBNP) and myocardial injury (Troponin‐T), taken at the time of the ICU TTE investigation, was analyzed using receiver‐operator characteristics curve (ROC) analysis. Results The overall mortality at the 24‐month follow‐up was 61.5% and 12.8% in group aPH and group non‐aPH, respectively. An increased relative mortality risk continued to be present in aPH patients (14.3%) compared to non‐aPH patients (5.6%) during the 1–24‐month period. The easily determined parameter of a tricuspid valve regurgitation, allowing a measurement of a systolic pulmonary artery pressure (regardless of magnitude), was associated with a similar K‐M outcome as the generally accepted diagnostic criteria for aPH (systolic pulmonary artery pressure >35 mmHg). The biomarker values of NTproBNP and Troponin‐T at the time of the TTE did not result in any clinically useful ROC analysis data. Conclusion The mortality risk was increased up to 24 months after the initial examination in ICU‐treated Covid‐19 patients with a TTE diagnosis of aPH, compared to non‐aPH patients. Certain individual TTE parameters were able to discriminate 24‐month risk of morality.

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Section: Discussionsupporting

confidence: 53%

Severe Covid‐19 and acute pulmonary hypertension: 24‐month follow‐up regarding mortality and relationship to initial echocardiographic findings and biomarkers

Norderfeldt

Liliequist

Eksborg

et al. 2022

Acta Anaesthesiol Scand

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“…Strengths of our study include its prospective design, that used images acquired predominantly by ICU clinicians with a range of echocardiography experience (reflecting day-to-day clinical practice). The comparative substantial limitations of retrospective design have been highlighted in a recent editorial on a multicentre echocardiography study in patients with COVID-19, with the authors commenting that "echocardiography exams were performed on clinical indication and not standardised which inferred some selection bias and some missing data" [39]. The echocardiography scans we obtained were study scans performed prospectively, giving an accurate representation of RVFWLS in COVID-19 patients undergoing IMV.…”

Section: Discussionmentioning

confidence: 99%

Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

McErlane

McCall

Willder

et al. 2022

Ann. Intensive Care

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Background Right ventricular (RV) dysfunction has been commonly reported in patients with Coronavirus disease 2019 (COVID-19), and is associated with mortality in mixed cohorts of patients requiring and not requiring invasive mechanical ventilation (IMV). Using RV-speckle tracking echocardiography (STE) strain analysis, we aimed to identify the prevalence of RV dysfunction (diagnosed by abnormal RV-STE) in patients with COVID-19 that are exclusively undergoing IMV, and assess association between RV dysfunction and 30 day mortality. We performed a prospective multicentre study across 10 ICUs in Scotland from 2/9/20 to 22/3/21. One-hundred-and-four echocardiography scans were obtained from adult patients at a single timepoint between 48 h after intubation, and day 14 of intensive care unit admission. We analysed RV-STE using RV free-wall longitudinal strain (RVFWLS), with an abnormal cutoff of > −20%. We performed survival analysis using Kaplan–Meier, log rank, and multivariate cox-regression (prespecified covariates were age, gender, ethnicity, severity of illness, and time since intubation). Results Ninety-four/one-hundred-and-four (90.4%) scans had images adequate for RVFWLS. Mean RVFWLS was −23.0% (5.2), 27/94 (28.7%) of patients had abnormal RVFWLS. Univariate analysis with Kaplan–Meier plot and log-rank demonstrated that patients with abnormal RVFWLS have a significant association with 30-day mortality (p = 0.047). Multivariate cox-regression demonstrated that abnormal RVFWLS is independently associated with 30-day mortality (Hazard-Ratio 2.22 [1.14–4.39], p = 0.020). Conclusions Abnormal RVFWLS (> −20%) is independently associated with 30-day mortality in patients with COVID-19 undergoing IMV. Strategies to prevent RV dysfunction, and treatment when identified by RVFWLS, may be of therapeutic benefit to these patients. Trial Registration: Retrospectively registered 21st Feb 2021. ClinicalTrials.gov Identifier: NCT04764032.

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Cardiac manifestations in critically ill patients with COVID-19: do we really know what hit us?

Cited by 2 publications

References 13 publications

Severe Covid‐19 and acute pulmonary hypertension: 24‐month follow‐up regarding mortality and relationship to initial echocardiographic findings and biomarkers

Severe Covid‐19 and acute pulmonary hypertension: 24‐month follow‐up regarding mortality and relationship to initial echocardiographic findings and biomarkers

Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

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