Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study

Karagodin, Ilya; Singulane, Cristiane Carvalho; Woodward, Gary; Xie, Mingxing; Tucay, Edwin S.; Rodrigues, Ana Clara Tude; Vasquez-Ortiz, Zuilma Y; Alizadehasl, Azin; Monaghan, Mark; Salazar, Bayardo A Ordonez; Soulat-Dufour, Laurie; Mostafavi, Atoosa; Moreo, Antonella; Citro, Rodolfo; Narang, Akhil; Wu, Chun; Descamps, Tine; Addetia, Karima; Lang, Roberto M.; Asch, Federico M.

doi:10.1016/j.echo.2021.05.010

Cited by 57 publications

(79 citation statements)

References 27 publications

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“…29 studies reported data about the prevalence of RVD 14 – 42 , while 7 reported about all-cause mortality according to RVD status 17 , 19 , 20 , 30 , 33 , 35 , 36 . 11 studies were held in Europe 16 , 18 – 21 , 33 – 36 , 38 , 40 , 8 in North America 23 , 25 , 26 , 28 , 29 , 37 , 41 , 42 , 3 in Asia 30 – 32 , and 7 in other geographical locations 14 , 15 , 17 , 22 , 24 , 27 , 39 , including 2 multinational studies 24 , 27 . Cohorts included were quite homogeneous in terms of mean age of the included patients (ranging from 52 years old to 68 years old); among sex, males were generally more represented than females (up to 84%).…”

Section: Resultsmentioning

confidence: 99%

“…The definition of RVD was heterogeneous across studies, both in terms of parameters and cut-offs used to defined RVD. 13 studies used a combination of several parameters 15 , 18 , 19 , 21 , 24 , 28 , 30 , 33 – 35 , 38 , 40 , 42 , 8 studies defined RVD according to TAPSE cut-off 14 , 16 , 22 , 23 , 31 , 32 , 36 , 39 , while other or unclear definitions of RVD was used in 8 studies 17 , 20 , 25 – 27 , 29 , 37 , 41 . In one study, a surrogate of Right Ventricular-Arterial uncoupling, which in turn relates the degree of RVD to the increase of pulmonary pressure, was addressed 20 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

Corica

Marra

Basili

et al. 2021

Sci Rep

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The Coronavirus Disease (COVID-19) pandemic imposed a high burden of morbidity and mortality. In COVID-19, direct lung parenchymal involvement and pulmonary microcirculation dysfunction may entail pulmonary hypertension (PH). PH and direct cardiac injury beget right ventricular dysfunction (RVD) occurrence, which has been frequently reported in COVID-19 patients; however, the prevalence of RVD and its impact on outcomes during COVID-19 are still unclear. This study aims to evaluate the prevalence of RVD and associated outcomes in patients with COVID-19, through a Systematic Review and Meta-Analysis. MEDLINE and EMBASE were systematically searched from inception to 15th July 2021. All studies reporting either the prevalence of RVD in COVID-19 patients or all-cause death according to RVD status were included. The pooled prevalence of RVD and Odds Ratio (OR) for all-cause death according to RVD status were computed and reported. Subgroup analysis and meta-regression were also performed. Among 29 studies (3813 patients) included, pooled prevalence of RVD was 20.4% (95% CI 17.1–24.3%; 95% PI 7.8–43.9%), with a high grade of heterogeneity. No significant differences were found across geographical locations, or according to the risk of bias. Severity of COVID-19 was associated with increased prevalence of RVD at meta-regression. The presence of RVD was found associated with an increased likelihood of all-cause death (OR 3.32, 95% CI 1.94–5.70). RVD was found in 1 out of 5 COVID-19 patients, and was associated with all-cause mortality. RVD may represent one crucial marker for prognostic stratification in COVID-19; further prospective and larger are needed to investigate specific management and therapeutic approach for these patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

Corica

Marra

Basili

et al. 2021

Sci Rep

View full text Add to dashboard Cite

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“…Treatment of pulmonary parenchymal and vascular pathology would therefore be expected to have a favorable effect on RV function, to the extent that these treatments are effective. Notwithstanding the underlying mechanisms for RV dysfunction, RV systolic dysfunction is associated with worse clinical outcomes 1 – 3 , 5 , 8 , 15 , 18 , 19 , 22 , 23 . In comparison with previous studies, the incidence of RV dysfunction was lower in our cohort but when present, it was still associated with worse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent reports linked COVID-19 infection to cardiac abnormalities as determined by echocardiography and CMR 1 – 23 . The presence of worse right ventricular (RV) function was shown to be associated with worse outcomes, albeit likely related to hypoxemia and pulmonary vascular abnormalities as opposed to primary cardiac disease.…”

Section: Introductionmentioning

confidence: 99%

Cardiac involvement in hospitalized patients with COVID-19 and its incremental value in outcomes prediction

Pournazari

Spangler

Ameer

et al. 2021

Sci Rep

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Recent reports linked acute COVID-19 infection in hospitalized patients to cardiac abnormalities. Studies have not evaluated presence of abnormal cardiac structure and function before scanning in setting of COVD-19 infection. We sought to examine cardiac abnormalities in consecutive group of patients with acute COVID-19 infection according to the presence or absence of cardiac disease based on review of health records and cardiovascular imaging studies. We looked at independent contribution of imaging findings to clinical outcomes. After excluding patients with previous left ventricular (LV) systolic dysfunction (global and/or segmental), 724 patients were included. Machine learning identified predictors of in-hospital mortality and in-hospital mortality + ECMO. In patients without previous cardiovascular disease, LV EF < 50% occurred in 3.4%, abnormal LV global longitudinal strain (< 16%) in 24%, and diastolic dysfunction in 20%. Right ventricular systolic dysfunction (RV free wall strain < 20%) was noted in 18%. Moderate and large pericardial effusion were uncommon with an incidence of 0.4% for each category. Forty patients received ECMO support, and 79 died (10.9%). A stepwise increase in AUC was observed with addition of vital signs and laboratory measurements to baseline clinical characteristics, and a further significant increase (AUC 0.91) was observed when echocardiographic measurements were added. The performance of an optimized prediction model was similar to the model including baseline characteristics + vital signs and laboratory results + echocardiographic measurements.

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“…Echocardiographic abnormalities, such as left ventricular systolic and diastolic dysfunction as well as right ventricular impairment, are observed in up to half of all COVID-19 patients undergoing echocardiography (21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19

Zwaenepoel

Dhont

Hoste

et al. 2021

Front. Cardiovasc. Med.

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Background: Early risk stratification is crucial in critically ill COVID-19 patients. Myocardial injury is associated with worse outcome. This study aimed to evaluate cardiac biomarkers and echocardiographic findings in critically ill COVID-19 patients and to assess their association with 30-day mortality in comparison to other biomarkers, risk factors and clinical severity scores.Methods: Prospective, single-center, cohort study in patients with PCR-confirmed, critical COVID-19. Laboratory assessment included high sensitive troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission to ICU: a hs-cTnT ≥ 14 pg/mL and a NT-proBNP ≥ 450 pg/mL were considered as elevated. Transthoracic echocardiographic evaluation was performed within the first 48 h of ICU admission. The primary outcome was 30-day all-cause mortality. Predictive markers for mortality were assessed by ROC analysis and cut-off values by the Youden Index.Results: A total of 100 patients were included. The median age was 63.5 years, the population was predominantly male (66%). At the time of ICU admission, 47% of patients had elevated hs-cTnT and 39% had elevated NT-proBNP. Left ventricular ejection fraction was below 50% in 19.1%. Elevated cardiac biomarkers (hs-cTnT P-value < 0.001, NT-proBNP P-value = 0.001) and impaired left ventricular function (P-value = 0.011) were significantly associated with mortality, while other biomarkers (D-dimer, ferritin, C-reactive protein) and clinical scores (SOFA) did not differ significantly between survivors and non-survivors. An optimal cut-off value to predict increased risk for 30-day all-cause mortality was 16.5 pg/mL for hs-cTnT (OR 8.5, 95% CI: 2.9, 25.0) and 415.5 pg/ml for NT-proBNP (OR 5.1, 95% CI: 1.8, 14.7).Conclusion: Myocardial injury in COVID-19 is common. Early detection of elevated hs-cTnT and NT-proBNP are predictive for 30-day mortality in patients with critical COVID-19. These markers outperform other routinely used biomarkers, as well as clinical indices of disease severity in ICU. The additive value of routine transthoracic echocardiography is disputable and should only be considered if it is likely to impact therapeutic management.

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Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study

Cited by 57 publications

References 27 publications

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

Cardiac involvement in hospitalized patients with COVID-19 and its incremental value in outcomes prediction

The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19

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