Echocardiographic predictors of mortality and morbidity in COVID-19 disease using focused cardiovascular ultrasound. (April 2022)

• Record Type: Journal Article
• Authors: Gomez, Joanne Michelle D.; Zimmerman, Allison C.; du Fay de Lavallaz, Jeanne; Wagner, John; Tung, Lillian; Bouroukas, Athina; Nguyen, Tai Tri P.; Canzolino, Jessica; Goldberg, Alan; Santos Volgman, Annabelle; Suboc, Tisha; Rao, Anupama K.
• Is Part Of: IJC heart & vasculature. Volume 39(2022)
• Publication Date: 2022-04
• Subjects: Echocardiography -- COVID-19 -- Mortality -- Prognosis; 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 coronavirus disease 2019 -- fTTE focused transthoracic 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 -- 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 -- RRT renal replacement therapy -- RV right ventricle / right ventricular -- RVLS right ventricular longitudinal strain -- S' peak lateral tricuspid annular systolic velocity -- SARS-CoV-2 novel SARS coronavirus -- TAPSE tricuspid annular plane systolic excursion; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2022.100982
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: Focused TTE is a critical diagnostic tool to limit exposure in COVID-19. Largest COVID-19 cohort to date showing strong prognostic power of RV parameters. RV dilation significantly associated with increased mortality in COVID-19. RV dysfunction significantly associated with shock in COVID-19. LV abnormalities did not provide prognostic information in COVID-19. 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.