Echocardiographic predictors of mortality and morbidity in COVID-19 disease using focused cardiovascular ultrasound.
Int J Cardiol Heart Vasc
; 39: 100982, 2022 Apr.
Article
in English
| MEDLINE | ID: covidwho-1703523
ABSTRACT
BACKGROUND:
Focused transthoracic echocardiography (fTTE) has emerged as a critical diagnostic tool during the COVID-19 pandemic, allowing for efficient cardiac imaging while minimizing staff exposure. The utility of fTTE in predicting clinical outcomes in COVID-19 remains under investigation.METHODS:
We conducted a retrospective study of 2,266 hospitalized patients at Rush University Medical Center with COVID-19 infection between March and November 2020 who received a fTTE. fTTE data were analyzed for association with primary adverse outcomes (60-day mortality) and with secondary adverse outcomes (need for renal replacement therapy, need for invasive ventilation, shock, and venous thromboembolism).RESULTS:
Of the 427 hospitalized patients who had a fTTE performed (mean 62 years, 43% female), 109 (26%) had died by 60 days. Among patients with an available fTTE measurement, right ventricular (RV) dilation was noted in 34% (106/309), 43% (166/386) had RV dysfunction, and 17% (72/421) had left ventricular (LV) dysfunction. In multivariable models accounting for fTTE data, RV dilation was significantly associated with 60-day mortality (OR 1.93 [CI 1.13-3.3], p = 0.016). LV dysfunction was not significantly associated with 60-day mortality (OR 0.95 [CI 0.51-1.78], p = 0.87).CONCLUSIONS:
Abnormalities in RV echocardiographic parameters are adverse prognosticators in COVID-19 disease. Patients with RV dilation experienced double the risk for 60-day mortality due to COVID-19. To our knowledge, this is the largest study to date that highlights the adverse prognostic implications of RV dilation as determined through fTTE in hospitalized COVID-19 patients.
ACE2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; ASE, American Society of Echocardiography; BNP, B-type natriuretic peptide; CCE, critical care echocardiography; CI, confidence interval; COVID-19; COVID-19, coronavirus disease 2019; Echocardiography; GLS, global longitudinal strain; IQR, interquartile range; IRB, institutional review board; LV, left ventricle / left ventricular; LVEDD, left ventricular end diastolic diameter; LVEF, left ventricular ejection fraction; Mortality; OR, odds ratio; PA, pulmonary artery; PCR, polymerase chain reaction; PLAX, parasternal long-axis view; POCUS, point-of-care ultrasound; PPE, personal protective equipment; PSAX, parasternal short-axis view; PUI, patient under investigation; Prognosis; RRT, renal replacement therapy; RV, right ventricle / right ventricular; RVLS, right ventricular longitudinal strain; SARS-CoV-2, novel SARS coronavirus; S', peak lateral tricuspid annular systolic velocity; TAPSE, tricuspid annular plane systolic excursion; fTTE, focused transthoracic echocardiography
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Observational study
/
Prognostic study
Language:
English
Journal:
Int J Cardiol Heart Vasc
Year:
2022
Document Type:
Article
Affiliation country:
J.ijcha.2022.100982
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