Risk prediction in patients with COVID-19 based on haemodynamic assessment of left and right ventricular function

Taieb, Philippe; Szekely, Yishay; Lupu, Lior; Ghantous, Eihab; Borohovitz, Ariel; Sadon, Sapir; Lichter, Yael; Ben‐Gal, Yanai; Banai, Ariel; Hochstadt, Aviram; Merdler, Ilan; Sapir, Orly; Granot, Yoav; Laufer‐Perl, Michal; Banai, Shmuel; Topilsky, Yan

doi:10.1093/ehjci/jeab169

Cited by 15 publications

(34 citation statements)

References 41 publications

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“…In a previous work, we were able to show that noninvasive echocardiographic hemodynamic parameters, such as low forward flow, high left and right filling pressures, and high RV afterload, are strongly associated with mortality. 33 , 34 This emphasized the importance of obtaining Doppler‐based hemodynamic parameters in patients with severe COVID‐19 infection. However, at the same time, we showed that in patients with mild disease, or low MEWS, mortality is low, irrespective of hemodynamic parameters.…”

Section: Discussionmentioning

confidence: 99%

Pericardial Involvement in Patients Hospitalized With COVID‐19: Prevalence, Associates, and Clinical Implications

Ghantous

Szekely

Lichter

et al. 2022

JAHA

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Background The scope of pericardial involvement in COVID‐19 infection is unknown. We aimed to evaluate the prevalence, associates, and clinical impact of pericardial involvement in hospitalized patients with COVID‐19. Methods and Results Consecutive patients with COVID‐19 underwent clinical and echocardiographic examination, irrespective of clinical indication, within 48 hours as part of a prospective predefined protocol. Protocol included clinical symptoms and signs suggestive of pericarditis, calculation of modified early warning score, ECG and echocardiographic assessment for pericardial effusion, left and right ventricular systolic and diastolic function, and hemodynamics. We identified predictors of mortality and assessed the adjunctive value of pericardial effusion on top of clinical and echocardiographic parameters. The study included 530 patients. Pericardial effusion was found in 75 (14%), but only 17 patients (3.2%) fulfilled the criteria for acute pericarditis. Pericardial effusion was independently associated with modified early warning score, brain natriuretic peptide, and right ventricular function. It was associated with excess mortality (hazard ratio [HR], 2.44; P =0.0005) in nonadjusted analysis. In multivariate analysis adjusted for modified early warning score and echocardiographic and hemodynamic parameters, it was marginally associated with mortality (HR, 1.86; P =0.06) and improvement in the model fit ( P =0.07). Combined assessment for pericardial effusion with modified early warning score, left ventricular ejection fraction, and tricuspid annular plane systolic excursion was an independent predictor of outcome (HR, 1.86; P =0.02) and improved model fit ( P =0.02). Conclusions In hospitalized patients with COVID‐19, pericardial effusion is prevalent, but rarely attributable to acute pericarditis. It is associated with myocardial dysfunction and mortality. A limited echocardiographic examination, including left ventricular ejection fraction, tricuspid annular plane systolic excursion, and assessment for pericardial effusion, can contribute to outcome prediction.

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Section: Discussionmentioning

confidence: 99%

Pericardial Involvement in Patients Hospitalized With COVID‐19: Prevalence, Associates, and Clinical Implications

Ghantous

Szekely

Lichter

et al. 2022

JAHA

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“…Previous studies have demonstrated the clinical utility of cardiac and lung POCUS for triage, diagnosis, and management of patients with COVID‐19 13–14 . Other studies also showed high rates of cardiac and pulmonary abnormalities, as well as the ability to predict a worse outcome in this group of patients 1,2,15,16 . However, most of these studies were performed with full‐size standard ultrasound machines.…”

Section: Discussionmentioning

confidence: 99%

The quality, safety, feasibility, and interpretive accuracy of echocardiographic and lung ultrasound assessment of COVID‐19 patients using a hand‐held ultrasound

et al. 2022

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Background The association between COVID‐19 infection and the cardiovascular system necessitates the use of an echocardiogram in this setting. Information on the utilization, safety, and quality of point‐of‐care cardiac and lung ultrasound using a hand‐held device in these patients is scarce. Aims To investigate the safety, technical aspects, quality indices, and interpretive accuracy of a hand‐held echocardiogram in patients with COVID‐19. Methods From April‐28 through July‐27, 2020, consecutive patients with COVID‐19 underwent hand‐held echocardiogram and lung ultrasound evaluation (Vscan Extend™; GE Healthcare) within 48‐h of admission. The operators recorded a series of technical parameters and graded individual experiences. The examinations were further analyzed by a blinded fellowship‐trained echocardiographer for general quality, proper acquisition, and right ventricular (RV) demonstration. Results Among 103 patients, 66 (64.1%) were male. Twenty‐nine (28.2%) patients could not turn on their left side and 23 (22.3%) could not maintain effective communication. The mean length of each echocardiogram study was 8.5 ± 2.9 min, battery usage was 14 ± 5%, and mean operator‐to‐patient proximity was 59 ± 11 cm. Ninety‐five (92.2%) examinations were graded as fair/good quality. A fair agreement was demonstrated between the operator and the echocardiographer for general ultrasound quality (Kappa = 0.329, p < 0.001). A fair‐good correlation (r = 0.679, p < 0.001) and substantial agreement (Kappa = 0.612, p < 0.001) were demonstrated between the operator and echocardiographer for left ventricular ejection fraction (LVEF), whereas a fair agreement was demonstrated for RV systolic function (Kappa = 0.308, p = 0.002). LVEF agreement was also assessed using the Bland‐Altman analysis revealing a mean bias of −0.96 (95% limits of agreement 9.43 to −11.35; p = 0.075). Conclusions Among patients with COVID‐19, echocardiography with a hand‐held ultrasound is a safe and reasonable alternative for a complete formal study (<10% poor‐quality indices). Echocardiogram assessment by the operators during the exam acquisition is reliable for LVEF, while RV systolic function should be subsequently offline reassessed.

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“…The cardiovascular abnormalities were reported in patients with severe disease and with mild disease as well [ 20 , 21 , 22 ]. Abnormal LV and RV strain during COVID-19 infection have been widely reported [ 4 , 21 , 22 , 23 , 24 ]. Abnormal LV and RV strain are also associated with poor prognosis [ 24 , 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Abnormal LV and RV strain during COVID-19 infection have been widely reported [ 4 , 21 , 22 , 23 , 24 ]. Abnormal LV and RV strain are also associated with poor prognosis [ 24 , 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Subclinical Myocardial Dysfunction in Patients Recovered from COVID-19 Disease: Correlation with Exercise Capacity

Shimoni

Korenfeld

Goland

et al. 2021

Biology

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Aims: Myocardial abnormalities are common during COVID-19 infection and recovery. We examined left (LV) and right (RV) ventricular longitudinal strain in patients who had recovered from COVID-19 and assessed the correlation with exercise capacity. Methods and results: One hundred and eighty-four consecutive patients with history of COVID-19 disease who had been referred to rest or stress echocardiography because of symptoms, mainly dyspnea and chest pain, were included in the study. These patients were compared to 106 patients with similar age, symptoms, and risk factor profile with no history of COVID-19 disease. Clinical and echocardiographic parameters, including strain imaging, were assessed. The patient’s age was 48 ± 12 years. Twenty-two patients had undergone severe disease. There were no differences in the LV ejection fraction and diastolic function between the groups. However, LV and RV global and free wall strain were significantly lower (in absolute numbers) in patients who had recovered form COVID-19 infection (−20.41 ± 2.32 vs −19.39 ± 3.36, p = 0.001, −23.69 ± 3.44 vs −22.09 ± 4.20, p = 0.001 and −27.24 ± 4.7 vs −25.43 ± 4.93, p = 0.021, respectively). Global Longitudinal Strain (GLS) < −20% was present in only 37% of post COVID-19 patients. Sixty-four patients performed exercise echocardiography. Patients with GLS < −20% had higher exercise capacity with higher peak metabolic equivalent and exercise time compared to patients with GLS ≥ −20% (12.6 ± 2 vs 10 ± 2.5 METss and 8:00 ± 2:08 vs 6:24 ± 2:03 min, p < 0.001 and p = 0.003, respectively). Conclusion: In patients, who had recovered from COVID-19 infection, both LV and RV strain are significantly lower compared to control patients. The exercise capacity of these patients correlates with LV strain values. Rest and stress echocardiography in patients with symptoms after COVID-19 infection may identify patients that need further follow up to avoid long term complications of the disease. These preliminary results warrant further research, to test the natural history of these findings and the need and timing of treatment.

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Risk prediction in patients with COVID-19 based on haemodynamic assessment of left and right ventricular function

Cited by 15 publications

References 41 publications

Pericardial Involvement in Patients Hospitalized With COVID‐19: Prevalence, Associates, and Clinical Implications

Pericardial Involvement in Patients Hospitalized With COVID‐19: Prevalence, Associates, and Clinical Implications

The quality, safety, feasibility, and interpretive accuracy of echocardiographic and lung ultrasound assessment of COVID‐19 patients using a hand‐held ultrasound

Subclinical Myocardial Dysfunction in Patients Recovered from COVID-19 Disease: Correlation with Exercise Capacity

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