Biventricular Longitudinal Strain Predict Mortality in COVID-19 Patients

Abstract

Background: Biventricular longitudinal strain has been recently demonstrated to be predictive of poor outcomes in various cardiovascular settings. Therefore, this study sought to investigate the prognostic implications of biventricular longitudinal strain in patients with coronavirus disease 2019 (COVID-19).Methods: We enrolled 132 consecutive patients with COVID-19. Left ventricular global longitudinal strain from the apical four-chamber views (LV GLS4CH) and right ventricular free wall longitudinal strain (RV FWLS) were obtained using two-dimensional speckle-tracking echocardiography.Results: Compared with patients without cardiac injury, those with cardiac injury had higher levels of coagulopathy and inflammatory biomarkers, higher incidence of complications, more mechanical ventilation therapy, and higher mortality. Patients with cardiac injury displayed decreased LV GLS4CH and RV FWLS, elevated pulmonary artery systolic pressure, and higher proportion of pericardial effusion. Higher biomarkers levels of inflammation and cardiac injury, and the presence of pericardial effusion were correlated with decreases in LV GLS4CH and RV FWLS. During hospitalization, 19 patients died. Compared with survivors, LV GLS4CH and RV FWLS were impaired in non-survivors. At a 3-month follow-up after discharge, significant improvements were observed in LV GLS4CH and RV FWLS. Multivariate Cox analysis revealed that LV GLS4CH [hazard ratio: 1.41; 95% confidence interval [CI]: 1.08 to 1.84; P = 0.011] and RV FWLS (HR: 1.29; 95% CI: 1.09–1.52; P = 0.003) were independent predictors of higher mortality in patients with COVID-19.Conclusions: LV GLS4CH and RV FWLS are independent and strong predictors of higher mortality in COVID-19 patients and can track improvement during the convalescent phase of their illness. Therefore, biventricular longitudinal strain may be crucial for risk stratification and serial follow-up in patients with COVID-19.

Cardiovascular Imaging Evaluation in COVID-19 Heart and Vascular Non-Ischaemic Involvement

“…Patients with cardiac injury were characterized by decreased strain of both LV and RV. These results were correlated with higher biomarkers levels of inflammation and cardiac injury, and the presence of pericardial effusion [165,166]. Moreover, patients who died were afflicted by impaired LS, an independent predictor of mortality in a Cox analysis.…”

“…Xie et al [165] investigated the prognostic implications of biventricular longitudinal strain in COVID-19 patients. They found that patients with cardiac injury had higher levels of coagulopathy and inflammatory biomarkers, higher incidence of complications, more mechanical ventilation therapies, and higher mortality.…”

Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19

“…Xie et al [ 165 ] investigated biventricular LS in COVID-19 patients as prognostic tool. They found that patients with cardiac injury had higher levels of inflammatory and coagulopathy markers, more mechanical ventilation therapies, higher incidence of complications, and higher mortality.…”

“…Heart involved patients were characterized by decreased of both LV and RV strain. These results were correlated with higher biomarkers of cardiac injury and inflammation as well as by the presence of pericardial effusion [ 165 , 166 ]. Moreover, patients who died were afflicted by impaired LS, an independent predictor of mortality in a Cox analysis.…”

“…Moreover, patients who died were afflicted by impaired LS, an independent predictor of mortality in a Cox analysis. Therefore, at 3-month follow-up visit after discharge in survivors, a significant improvement was observed in both right and left LS [ 165 ]. However, RVLS worsened in patients who experienced hospitalization due to their clinical conditions, especially if they had severe pneumonia [ 166 ].…”