A pilot study on right ventricular longitudinal strain as a predictor of outcome in COVID‐19 patients with evidence of cardiac involvement

Abstract

Aims The aim of this investigation was to evaluate echocardiographic parameters of cardiac function and in particular right ventricular (RV) function as a predictor of mortality in patients with coronavirus disease‐2019 (COVID‐19) pneumonia. Methods and Results This prospective observational study included 35 patients admitted to a UK district general hospital with COVID‐19 and evidence of cardiac involvement, that is, raised Troponin I levels or clinical evidence of heart failure during the first wave of the COVID‐19 pandemic (March–May 2020). All patients underwent echocardiography including speckle tracking for right ventricular longitudinal strain (RVLS) providing image quality was sufficient (30 out of 35 patients). Upon comparison of patients who survived COVID‐19 with non‐survivors, survivors had significantly smaller RVs (basal RV diameter 38.2 vs 43.5 mm P = .0295) with significantly better RV function (Tricuspid annular plane systolic excursion (TAPSE): 17.5 vs 15.3 mm P = .049; average RVLS: 24.3% vs 15.6%; P = .0018). Tricuspid regurgitation (TR) maximal velocity was higher in survivors (2.75 m/s vs 2.11 m/s; P = .0045) indicating that pressure overload was not the predominant driver of this effect and there was no significant difference in left ventricular (LV) ejection fraction. Kaplan–Meier and log‐rank analysis of patients split into groups according to average RVLS above or below 20% revealed significantly increased 30‐day mortality in patients with average RVLS under 20% (HR: 3.189; 95% CI: 1.297–12.91; P = .0195). Conclusion This study confirms that RVLS is a potent and independent predictor of outcome in COVID‐19 patients with evidence of cardiac involvement.

Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID‐19: A systematic review

“…79 In another study of 35 patients, those with RVGLS less than -20% had significantly higher 30 day mortality. 83 RVFAC performed inconsistently in prediction of mortality in COVID-19 patients. In one study that included COVID-19 patients with varying severity, RVFAC was reported to be an independent predictor of mortality.…”

COVID-lateral damage: cardiovascular manifestations of SARS-CoV-2 infection

“…142,143 In a prospective study of 214 patients with COVID19, measures of RV function and LV function were significantly associated with mortality 164 . Small studies suggest that even subclinical ventricular dysfunction (LV and RV strain by echocardiography) is associated with mortality in patients with COVID19 [164][165][166] . Arrhythmia in COVID19 also portend higher risk of mortality.…”

Long term effects of mild severity COVID‑19 on right ventricular functions

“…Li et al reported that despite normal left ventricular ejection fraction values, decreased RV-LS is a strong predictor of mortality in COVID-19 patients [ 17 ]. In another study, it is demonstrated that decreased RV-GLS values were detected to be strong and independent predictor of poor outcomes in patients with COVID-19 [ 18 ]. Baycan et al expressed that decreased RV-GLS is related to in-hospital mortality in COVID-19 cases [ 5 ].…”