Right ventricular strain in in COVID-19 patients: a single-center experience

ABSTRACT

BACKGROUND: Assessment of right ventricular systolic function using strain imaging analysis from two-dimensional echocardiography has been identified to have powerful predictive value. Utilization of right ventricular strain may provide additional information in the management of COVID-19 patients. OBJECTIVE: To determine and analyze the right ventricular systolic function using longitudinal strain imaging among COVID-19 patients. METHOD: This is a prospective cohort study of the right ventricular function using speckle tracking echocardiography among COVID-19 patients. The study included two dimensional (2D) echocardiographic studies among 137 adult patients with laboratory-confirmed COVID-19 from September to November 2020. Analysis of Variance (ANOVA) was used to compare more than two groups with numerical data. Pearson Correlation was utilized to determine correlation between numerical variables. RESULTS: The results showed a total of 35 patients (25.54%) to have abnormal right ventricular free wall strain. The results showed that there was a significant direct correlation between right ventricular free wall strain and the echocardiographic parameters of tricuspid annular plane systolic excursion (TAPSE) (r = 0.277;p = 0.001), S' (r = 0.166;p = 0.050), right ventricular fractional area change (r = 0.298;p < 0.0001) and left ventricular ejection fraction (LVEF) (r = 0.176;p = 0.040). There was a significant inverse correlation noted between right ventricular free wall strain and the echocardiographic parameters of the tricuspid regurgitation (r=-0.284;p = 0.001), pulmonary arterial systolic pressure (r=-0.209;p = 0.014) and left atrial size (r=-0.209;p = 0.014). There was a significant difference in the right ventricular free wall strain according to the severity of COVID-19 infection (p = 0.032). Moreover, a significant difference was also noted between right ventricular free wall strain and mortality (p = 0.0001). The mean right ventricular free wall strain of patients who died was significantly lower than those who were discharged with a mean of 18.92% and 23.59% respectively. CONCLUSION: Right ventricular free wall strain using speckle tracking echocardiography, can be used for risk stratification for patients with COVID-19. It also showed that it is has significant correlation with the severity of the disease and mortality. These findings together with other conventional echocardiographic parameters, may provide clinicians additional information in the management of these patients.