Could strain echocardiography help to assess systolic function in critically ill COVID-19 patients?

Abstract

Strain echocardiography enables the automatic quantification of the global longitudinal strain (GLS), which is a direct measure of ventricular shortening during systole. In the current context of overwhelmed ICUs and clinician shortage, GLS has the advantage to be quick and easy to measure by non-experts. However, little is known regarding its value to assess bi-ventricular systolic function in critically ill COVID-19 patients. Therefore, we designed a study to compare right and left ventricular GLS with classic echo-Doppler indices of systolic function, namely the ejection fraction for the left ventricle (LVEF) and the fractional area change (FAC), the tricuspid annular plane systolic excursion (TAPSE), and the tissue Doppler velocity of the basal free lateral wall (S’) for the right ventricle. Eighty transthoracic echocardiographic evaluations done in 30 ICU patients with COVID-19 were analyzed. We observed a fair relationship (r = 0.73, p < 0.01) between LVEF and left ventricular GLS. The GLS cut-off value of − 22% identified a LVEF < 50% with a sensitivity of 63% and a specificity of 80%. All patients with a GLS > − 17% had a LVEF < 50%. Although statistically significant, relationships between FAC (r = 0.41, p < 0.01), TAPSE (r = 0.26, p < 0.05) and right ventricular GLS were weak. S’ was not correlated with right ventricular GLS. In conclusion, left ventricular GLS was useful to assess left ventricular systolic function. However, right ventricular GLS was poorly correlated with FAC, TAPSE and S’. Further studies are needed to clarify what is the best method to assess right ventricular systolic function in ICU patients with COVID-19.

Characteristic Immune Dynamics in COVID-19 Patients with Cardiac Dysfunction

“…Left and right ventricular systolic dysfunction measured by GLS had an incidence similar to other reports [ 54 ]. Although LV GLS was not significantly different from the other usual systolic function parameters, RV GLS was poorly correlated with FAC, TAPSE and RV S’, as previously demonstrated by our group [ 55 ]. Our cohort’s 36.7% incidence of RV dysfunction is in line with previous publications [ 54 ] and could be attributed to the parenchymal or microvascular disease in COVID-19.…”

Coronavirus Disease 2019: There Is a Heart Between the Lungs*

“…In other words, the assessment of TAPSE did not add anything to the assessment of RV FAC. These findings are consistent with the results of previous reports done in patients with septic shock ( 10 ) and in patients with COVID-19 ( 11 ).…”

Transthoracic echocardiography of patients in prone position ventilation during the COVID-19 pandemic: an observational and retrospective study

“…The evaluation of the RV focused on the visual estimation of its systolic function, the measurement of the RV/LV basal diameter ratio, TAPSE in most cases, and the S′ wave in some, acknowledging that there is active research on the best assessment of this topic [ 23 – 27 ].…”