Echocardiographic abnormalities and predictors of mortality in hospitalized COVID‐19 patients: the ECHOVID‐19 study

Abstract

Aims The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death. Methods and results In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by predetermined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease. Conclusions RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.

Cardiac Dysfunction in Critically Ill patients with COVID-19 – A Multicentre Observational Study

“…In a sub-group analysis, RV dysfunction and elevated PAP were independently associated with an increased risk of death. This is consistent with ndings from other studies of patients with ARDS and hospitalized patients with COVID-19 [13,14]. Regrettably, the main cause of death was not registered in the present study, and patients were not systematically assessed for pulmonary embolism.…”

“…Cardiac complications, on a case report basis, include myocarditis [8][9][10], COVID-19 associated Takotsubo cardiomyopathy [11,12], and myocardial infarction [12]. Several studies have reported abnormalities in left and right ventricular function in a large proportion of patients with COVID-19 undergoing echocardiography [12][13][14][15]. Studies have also shown that left and right ventricular dysfunction are independently correlated to increased mortality in patients with COVID-19 [14,16].…”

Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study

“…Several studies in COVID-19 with or without critical illness have suggested an association between markers of RV/LV dysfunction and COVID-19 related death [ 26 , 27 ]. In our work, no association was found between 28-day mortality and echocardiographic variables, except for lower E/A values in non-survivors.…”

Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

“…Routine echocardiography is also useful in critical care settings. Global longitudinal strain (GLS) measurement provides direct measurement of myocardial deformation; thus, it is less affected by different loading conditions compared to ejection fraction [4]. Ventricular strain has been shown to be a useful tool for prognostication in patients with acute respiratory distress syndrome (ARDS) [5].…”