RESUMO
Right ventricular (RV) free wall longitudinal strain (RVFWLS), and four-chamber longitudinal strain (RV4CLS) using speckle tracking echocardiography have demonstrated increased accuracy and discrimination to measure right ventricular function in different clinical conditions. Reproducibility data of these measures are scarce and mainly tested in small or reference populations. The main objective of this study was to investigate their reproducibility, and of other traditional RV parameters, from unselected participants of a large cohort study. RV strain reproducibility was analyzed using echocardiographic images of 50 participants from a randomly selected sample from The ELSA-Brasil Cohort. Images were acquired and analyzed following the study protocols. The mean RVFWLS was - 26.9 ± 2.6% and the mean RV4CLS was - 24.4 ± 1.9%. The intra-observer reproducibility parameters of RVFWLS demonstrated a coefficient of variation (CV) of 5.1% and an intraclass correlation coefficient (ICC [95%CI] 0.78[0.67-0.89]), and for RV4CLS were CV = 5.1% and ICC = 0.78[0.67-0.89]. Reproducibility for RV fractional area change was CV = 12.1%; ICC = 0.66 [0.50-0.81] and for RV basal diameter was CV = 6.3%; ICC = 0.82 [0.73-0.91]. The inter-observer reproducibility for RVFWLS was CV = 8.3%; ICC 0.54[0.34-0.74] and for RV4CLS, CV = 6.3%; ICC = 0.53[0.34-0.73], following the same pattern among conventional RV parameters. We found adequate reproducibility of RV longitudinal strain parameters. This information is relevant for the long-term follow-up of cohort participants and reinforces the utility of RV longitudinal strain as a tool to monitor subclinical changes in RV systolic function.
RESUMO
PURPOSE: The burden of critical COVID-19 patients in intensive care units (ICU) demands new tools to stratify patient risk. We aimed to investigate the role of cardiac and lung ultrasound, together with clinical variables, to propose a simple score to help predict short-term mortality in these patients. MATERIAL AND METHODS: We collected clinical and laboratorial data, and a point-of-care cardiac and lung ultrasound was performed in the first 36 h of admission in the ICU. RESULTS: Out of 78 patients (61 ± 12y-o, 55% male), 33 (42%) died during the hospitalization. Deceased patients were generally older, had worse values for SOFA score, baseline troponin levels, left ventricular ejection fraction (LVEF), LV diastolic function, and increased epicardial fat thickness (EFT), despite a similar prevalence of severe lung ultrasound scores. Based on the multivariable model, we created the POCOVID score, including age (>60 years), myocardial injury (LVEF<50% and/or usTnI>99til), and increased EFT (>0.8 cm). The presence of two out of these three criteria identified patients with almost twice the risk of death. CONCLUSIONS: A higher POCOVID score at ICU admission can be helpful to stratify critical COVID-19 patients with increased in-hospital mortality and to optimize medical resources allocation in more strict-resource settings.
