ABSTRACT
Introduction: Myocardial damage has been widely described in patients with COVID-19. Right ventriculoarterial coupling (RVAC) is a marker of subclinical myocardial damage. The association with mortality in COVID-19 patients has been recently investigated. Objectives: To determine if there is a difference in patients with abnormal vs normal RVAC, in clinical, laboratory and echocardiographic variables. Analyze if there is an association between the presence of abnormal RVAC and one-year mortality. Investigate the cutoff value of the RVAC to predict mortality. Methods.: A single-center, prospective, analytical study. Patients with a diagnosis of COVID-19 were included. Patients who were on mechanical ventilation during the study, a history of ischemic heart disease, valvular heart disease, and chronic obstructive pulmonary disease were excluded. The patients were included during the period from May to August 2020, the 1-year follow-up was carried out through the electronic medical record and telephone calls. The echocardiograms were performed with the Phillips IE-33, the strain determination was obtained with the Qlab 13.0 software. The quantitative variables were compared with the Student's T test or the U Mann-Whitney test, according to the normality of the variables;qualitative variables were contrasted with the x2 test. One-year survival was determined with the Kaplan-Meier curves, and the association with one-year mortality was investigated with Cox regression. The cut-off value for predicting mortality was determined with ROC curves. The RVAC was determined with the right ventricular free wall longitudinal strain / pulmonary systolic artery pressure ratio. Abnormal right ventriculoarterial coupling was determined with a value less than 0.8. Results: 81 patients were included, of whom 45 had an abnormal RVAC. Patients with abnormal RVAC had higher mortality and a higher requirement for mechanical ventilation;they had higher levels of biomarkers. Among the echocardiographic variables, they had lower the right ventricular fractional area change, the tricuspid annular plane systolic excursion, the left ventricular longitudinal strain, the left atrial reservoir strain, the right ventricular free wall longitudinal strain, the RVAC;while they also presented higher the pulmonary systolic artery pressure and the tricuspid regurgitation velocity. The one-year survival of patients with abnormal RVAC was 53% vs 91%, the association with 1-year mortality was HR: 7.0 (CI95 2.1-23;p = 0.0001). The cutoff value of the RVAC to predict mortality was <0.48 (Sensitivity 71%, Specificity 90%, AUC: 0.836;p = <0.0001). Conclusion: The patients with COVID-19 and an abnormal RVAC had a higher requirement for mechanical ventilation and mortality;presented higher levels of biomarkers. Half of the patients with abnormal RVAC died, presenting an association to predict mortality. The cut-off value of <0.48 was the best associated with mortality.
ABSTRACT
Background: Coronavirus disease 2019 is a systemic entity, where cardiac involvement has been described. The echocardiogram is a diagnostic tool that describes myocardial damage with good certainty. Objectives: Determine which echocardiographic parameters are predictors of mortality. Analyze if there is a difference in clinical, laboratory and echocardiographic variables in terms of patients who died versus those who survived. Investigate the cut-off point of the echocardiographic parameters that is best associated with mortality. Methods: Prospective, analytical, comparative study. Patients admitted to the hospital with Coronavirus 2019 infection. Clinical, laboratory and echocardiographic variables will be assessed. The association with threemonth mortality of the different variables will be determined. We used ROC-curves for the best cut-off associated with mortality. The association with three-month mortality was analized using Cox regression, unadjusted analysis of the variables was performed, as well as adjusted analysis for age and gender. Results: 84 patients were included, a mortality of 29% was documented. Significant differences were found in the left atrial volumen index, the E/e', the proportion of dilatation of the right ventricle and diastolic dysfunction. Tricuspid annulus anterior systolic excursion (TAPSE), pulmonary artery acceleration time (PAA), tricuspid regurgitation velocity (TRV), pulmonary artery systolic pressure (PASP), left ventricular longitudinal strain (LVGLS), of the left atrium (LAGLS) and the right ventricular free wall longitudinal strain (RVFWLS). Right ventricular dilation, right ventricular shortening fraction, TAPSE, PASP, TRV, LVGLS, LAGLS, and RVFWLS were associated with mortality. Conclusion: Right ventricular dilation, right ventricular shortening fraction, TAPSE, PASP, TRV, LVGLS, LAGLS, and RVFWLS are the echocardiographic parameters that were associated with three-month mortality. (Figure Presented).