Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

Abstract

Background This systematic review and meta-analysis aimed to assess whether ventricular longitudinal strain can be used as a prognostication tool in patients with coronavirus disease 2019 (COVID-19). Methods Systematic literature searches of PubMed, Embase, and EuropePMC databases were performed on 16 November 2020. Left ventricular global longitudinal strain (LV-GLS) refers to LV contraction measurement using the speckle tracking-based method refers to the mean of strain values of the RV free wall (three segments) measured using echocardiography. The main outcome was poor outcome, defined as a composite of mortality and severe COVID-19. Results Seven studies comprising of 612 patients were included in meta-analysis. Six studies have mortality as their outcome, and 1 study has severity as their outcome. Patients with poor outcome have lower LV-GLS (SMD 1.15 (0.57, 1.72), p < 0.001; I2 70.4%). Each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome (OR 1.37 (1.12, 1.67), p = 0.002; I2 48.8%). Patients with poor outcome have lower RV-LS (SMD 1.18 (0.91, 1.45), p < 0.001; I2 0%). Each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome (OR 1.25 (1.15, 1.35), p < 0.001; I2 11.8%). Subgroup analysis showed that for every 1% decrease in LV-GLS and RV-LS is increased mortality with OR of 1.30 (1.12, 1.50) and OR of 1.24 (1.14, 1.35), respectively. Conclusion This study shows that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19. Trial registration PROSPERO CRD42020221144

Active prescription of low-dose aspirin during or prior to hospitalization and mortality in COVID-19: A systematic review and meta-analysis of adjusted effect estimates

“…Elevation of inflammatory and coagulation parameters and derangement of various laboratory values are noted in patients with more severe SARS-COV-2 infection, indicating poor prognosis ( Akbar et al, 2021 , Huang et al, 2020b ). These alteration may lead to cardiac injuries that were strongly associated with mortality ( Martha et al, 2021 , Pranata et al, 2020b , Wibowo et al, 2021a , Wibowo et al, 2021b ). As cytokine storm is the underlying mechanism behind multisystem inflammatory process in severe COVID-19, the use of aspirin could theoretically a promising option in improving patients’ outcomes and hindering the development of fatal complications, including ARDS, coagulopathy, sepsis, multi-organ dysfunction, and death ( Lim et al, 2020 , Pranata et al, 2021e ).…”

Tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography and mortality in COVID-19: A systematic review and meta-analysis

“…Hence, measuring RVLS in patients with a clinical suspicion of heart failure or a finding of elevated troponin levels may effectively forecast J o u r n a l P r e -p r o o f clinical outcomes and determine whether high-level intervention is required. (Stockenhuber et al, 2020;Wibowo et al, 2021) Multiple studies has found that RV strain and TAPSE were associated with higher severity and mortality. (Bursi et al, 2020;D'Alto et al, 2020;Lassen et al, 2020;Li et al, 2020;Liu et al, 2020;Sattarzadeh Badkoubeh et al, 2021;Stockenhuber et al, 2020) LV function is usually preserved or hyperdynamic in COVID-19 patients.…”

“…(Raymond Pranata et al, 2020a) COVID-19 itself is associated with myocardial injury and impaired right ventricle (RV) strain, which are independent predictors of poor prognosis. (D'Alto et al, 2020;Wibowo et al, 2021) Meanwhile, left ventricle (LV) function is usually relatively unaffected in the majority of COVID-19 patients. (Moody et al, 2020) Acute cor pulmonale or right heart failure (RHF) is a J o u r n a l P r e -p r o o f long-established complication of ARDS, in relation to disease severity and ventilatory strategies associated with permissive hypercapnia and pulmonary hyperinflation.…”

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

“…Their meta-analysis included seven studies and 612 patients. They found that each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome, while each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome [168].…”

“…RV LS is not related to abnormal lung mechanics or ventilatory pressures [167]. A recent systematic review on LS both of LV and RV showed that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19 [168]. Authors evaluated clinical trials that analysed as outcome a composite of mortality and severe COVID-19.…”