Prognostic Value of Left Ventricular Global Longitudinal Strain in COVID-19

Janus, Scott E.; Hajjari, Jamal; Karnib, Mohamad; Tashtish, Nour; Al‐Kindi, Sadeer G.; Hoit, Brian D.

doi:10.1016/j.amjcard.2020.06.053

Cited by 35 publications

(38 citation statements)

References 4 publications

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“…Importantly, conventional assessment of LV function by LVEF did not reveal differences between groups of myocardial injury. In line with the findings of a recent study of Janus et al [ 7 ], we observed that rather LV-GLS than LVEF is the modality of choice to detect systolic left ventricular dysfunction (LVD sys ) in patients with COVID-19-associated myocardial injury. LVD sys was mainly detected by impaired LV-GLS (12 out of 19 patients with LVD sys ).…”

Section: Discussionsupporting

confidence: 91%

“…Previous echocardiographic reports of COVID-19 patients could not show impairment of left ventricular (LV) function by conventional ejection fraction (LVEF) [ 5 ]. Recent retrospective studies revealed that either left or right ventricular dysfunction was observed in longitudinal strain measurements, possibly predicting mortality in COVID-19 patients [ 6 , 7 ]. So far, advanced three-dimensional and strain echocardiography (3DSE) has been lacking as part of the comprehensive clinical evaluation of COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

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Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

et al. 2021

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Purpose SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout the pandemic course in 2019, its morphological characterisation is still unclear. With this study, we aimed to characterise echocardiographic patterns of ventricular function in patients with COVID-19-associated myocardial injury. Methods We prospectively assessed 32 patients hospitalised with COVID-19 and presence or absence of elevated high sensitive troponin T (hsTNT+ vs. hsTNT-) by comprehensive three-dimensional (3D) and strain echocardiography. Results A minority (34.3%) of patients had normal ventricular function, whereas 65.7% had left and/or right ventricular dysfunction defined by impaired left and/or right ventricular ejection fraction and strain measurements. Concomitant biventricular dysfunction was common in hsTNT+ patients. We observed impaired left ventricular (LV) global longitudinal strain (GLS) in patients with myocardial injury (-13.9% vs. -17.7% for hsTNT+ vs. hsTNT-, p = 0.005) but preserved LV ejection fraction (52% vs. 59%, p = 0.074). Further, in these patients, right ventricular (RV) systolic function was impaired with lower RV ejection fraction (40% vs. 49%, p = 0.001) and reduced RV free wall strain (-18.5% vs. -28.3%, p = 0.003). Myocardial dysfunction partially recovered in hsTNT + patients after 52 days of follow-up. In particular, LV-GLS and RV-FWS significantly improved from baseline to follow-up (LV-GLS: -13.9% to -16.5%, p = 0.013; RV-FWS: -18.5% to -22.3%, p = 0.037). Conclusion In patients with COVID-19-associated myocardial injury, comprehensive 3D and strain echocardiography revealed LV dysfunction by GLS and RV dysfunction, which partially resolved at 2-month follow-up. Trial registration COVID-19 Registry of the LMU University Hospital Munich (CORKUM), WHO trial ID DRKS00021225.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

et al. 2021

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“…9 Abnormalities in RV strain and LV GLS have also been reported and indicate subclinical myocardial injury. 5 , 6 Importantly, CMR in a significant proportion of recovered COVID-19 patients revealed fibrosis and edema predominantly in the basal and mid LV segments, corresponding with our STE findings. 8 Case reports and series of patients with various forms of myocarditis, including influenza myocarditis, have described a similar pattern of reduced basal strain on STE.…”

Section: Discussionsupporting

confidence: 86%

“… 1 , 2 , 3 , 4 Various forms of myocardial injury, defined by elevated cardiac biomarkers and/or abnormalities on transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) have been reported. 2 , 5 , 6 , 7 , 8 , 9 TTE can be particularly useful in the inpatient setting to quickly and inexpensively evaluate regional myocardial injury, however due to the infectious risk to medical staff, routine echocardiography for all COVID-19 patients should be avoided. 10 …”

Section: Introductionmentioning

confidence: 99%

Prominent Longitudinal Strain Reduction of Basal Left Ventricular Segments in Patients With Coronavirus Disease-19

Goerlich

Gilotra

Minhas

et al. 2021

Journal of Cardiac Failure

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“…Ventricular strain has been shown to be a useful tool for prognostication in patients with acute respiratory distress syndrome (ARDS) [5]. Studies indicate the potential use of ventricular strain assessment for prognostication in patients with COVID-19 [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background This systematic review and meta-analysis aimed to assess whether ventricular longitudinal strain can be used as a prognostication tool in patients with coronavirus disease 2019 (COVID-19). Methods Systematic literature searches of PubMed, Embase, and EuropePMC databases were performed on 16 November 2020. Left ventricular global longitudinal strain (LV-GLS) refers to LV contraction measurement using the speckle tracking-based method refers to the mean of strain values of the RV free wall (three segments) measured using echocardiography. The main outcome was poor outcome, defined as a composite of mortality and severe COVID-19. Results Seven studies comprising of 612 patients were included in meta-analysis. Six studies have mortality as their outcome, and 1 study has severity as their outcome. Patients with poor outcome have lower LV-GLS (SMD 1.15 (0.57, 1.72), p < 0.001; I2 70.4%). Each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome (OR 1.37 (1.12, 1.67), p = 0.002; I2 48.8%). Patients with poor outcome have lower RV-LS (SMD 1.18 (0.91, 1.45), p < 0.001; I2 0%). Each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome (OR 1.25 (1.15, 1.35), p < 0.001; I2 11.8%). Subgroup analysis showed that for every 1% decrease in LV-GLS and RV-LS is increased mortality with OR of 1.30 (1.12, 1.50) and OR of 1.24 (1.14, 1.35), respectively. Conclusion This study shows that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19. Trial registration PROSPERO CRD42020221144

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Prognostic Value of Left Ventricular Global Longitudinal Strain in COVID-19

Abstract: ; societ a Italiana di cardiologia and the CCU academy investigators group. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era.

Cited by 35 publications

References 4 publications

Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

Prominent Longitudinal Strain Reduction of Basal Left Ventricular Segments in Patients With Coronavirus Disease-19

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

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