The Predictive Role of Left and Right Ventricular Speckle-Tracking Echocardiography in COVID-19

Rothschild, Ehud; Baruch, Guy; Szekely, Yishay; Lichter, Yael; Kaplan, Alon; Taieb, Philippe; Laufer‐Perl, Michal; Beer, Gil; Kapusta, Livia; Topilsky, Yan

doi:10.1016/j.jcmg.2020.07.026

Cited by 30 publications

(44 citation statements)

References 5 publications

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“…A quick POCUS cardiac evaluation is therefore highly desirable in this context, but a surge of acutely ill patients may limit the feasibility of an operator-dependent and time-consuming procedure [ 14 ]. Recent studies suggest that a decrease in right and left ventricular GLS is an independent predictive factor of tracheal intubation and in-hospital mortality in COVID-19 patients [ 7 , 8 ]. The ability to quickly assess both right and left ventricular function with strain echocardiography, regardless of the operator training level [ 3 , 4 ], is therefore very appealing in this context.…”

Section: Discussionmentioning

confidence: 99%

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

Gonzalez

Bacariza

Michard

2021

J Clin Monit Comput

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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.

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Section: Discussionmentioning

confidence: 99%

“…In COVID-19 patients, a limited number of echocardiographic evaluations have been done with speckle tracking [ 7 – 9 ]. These evaluations have reported a frequent decrease in right and left ventricular GLS, but they did not provide any comparison with classic indices of systolic function.…”

mentioning

confidence: 99%

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

Gonzalez

Bacariza

Michard

2021

J Clin Monit Comput

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“… Giustino et al (2020) reported that patients with myocardial injury more suffered from left ventricle dysfunction, regional wall motion abnormalities, right ventricle dysfunction, and pericardial effusions. Additionally, recently researches assessed by speckle-tracking echocardiography supported that worsening left ventricle and right ventricle function, reflected by reduced global and regional strain, were more observed in patients with severe COVID-19 infection and more associated with poorer grade and clinical deterioration ( Lassen et al, 2020 ; Rothschild et al, 2020 ). Meanwhile, 12-lead electrocardiogram identified that two different patterns of ST-segment changes, including global biventricular dysfunction related diffuse ST-segment changes and regional wall motion abnormalities associated regional ST-segment changes ( Giustino et al, 2020 ).…”

Section: Discussionmentioning

confidence: 90%

Sex Differences in the Incidence and Risk Factors of Myocardial Injury in COVID-19 Patients: A Retrospective Cohort Study

et al. 2021

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Male novel coronavirus disease (COVID-19) patients tend to have poorer clinical outcomes than female patients, while the myocardial injury is strongly associated with COVID-19-related adverse events. Owing to a lack of corresponding data, we aimed to investigate the sex differences in the incidence of myocardial injury in COVID-19 patients and to identify the potential underlying mechanisms, which may partly account for the sex bias in the incidence of adverse events. This retrospective study included 1,157 COVID-19 patients who were hospitalized in Huoshenshan Hospital from 12 March 2020 to 11 April 2020. Data on the patients’ demographic characteristics, initial symptoms, comorbidities and laboratory tests were collected. Totally, 571 (49.4%) female and 586 (50.6%) male COVID-19 patients were enrolled. The incidence of myocardial injury was higher among men than women (9.2 vs. 4.9%, p = 0.004). In the logistic regression analysis, age, and chronic kidney disease were associated with myocardial injury in both sexes. However, hypertension [odds ratio (OR) = 2.25, 95% confidence interval (CI) 1.20–4.22], coronary artery disease (OR = 2.46, 95% CI 1.14–5.34), leucocyte counts (OR = 3.13, 95% CI 1.24–7.86), hs-CRP (OR = 4.45, 95% CI 1.33–14.83), and D-dimer [OR = 3.93 (1.27–12.19), 95% CI 1.27–12.19] were independent risk factors only in the men. The correlations of hs-CRP and D-dimer with hs-cTnI and BNP were stronger in the men. The incidence of myocardial injury in COVID-19 patients is sex-dependent, predominantly in association with a greater degree of inflammation and coagulation disorders in men. Our findings can be used to improve the quality of clinical management in such settings.

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“…The cardiac abnormalities reported to date among patients with COVID-19 are wide ranging and include the following: acute Abbreviations: AT, acceleration time; BAME, Black, Asian and minority ethnic; CTA, computed tomography angiography; CMR, cardiac magnetic resonance; CRP, C-reactive protein; COVID-19, coronavirus disease 2019; D-dimer, fibrin degradation products; E, early transmitral peak Doppler velocity; e ′ , early tissue Doppler peak velocity; ECV, extracellular volume; hs-cTn, high-sensitivity cardiac troponin; hs-cTnI, high-sensitivity cardiac troponin I; hs-cTnT, high-sensitivity cardiac troponin T; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; LVEF, left ventricular ejection fraction; LGE, late gadolinium enhancement; LVGLS, left ventricular global longitudinal strain; LVSD, left ventricular systolic dysfunction; RV, right ventricle; RVEF, right ventricular ejection fraction; RVEDA, right ventricular end-diastolic area; RVESA, right ventricular end-systolic area; RVEDV, right ventricular end-diastolic volume; RVESV, right ventricular endsystolic volume; RVFWLS, right ventricular free-wall longitudinal strain; RVGLS, right ventricular global longitudinal strain; S ′ , peak systolic tissue Doppler velocity; STE, speckle tracking echocardiography; PASP, pulmonary artery systolic pressure; PADP, pulmonary artery diastolic pressure; RVSD, right ventricular systolic dysfunction; T2 STIR, short tau inversion recovery; TAPSE, tricuspid annular plane peak systolic excursion; TTE, transthoracic echocardiography; TOE, transoesophageal echocardiography; TAVI, transcutaneous aortic valve intervention; TMVR, transcutaneous mitral valve intervention; TR Vmax, tricuspid regurgitant peak velocity. coronary syndromes (15), Takotsubo cardiomyopathy (16,17), myocarditis (18), right heart dysfunction/acute cor pulmonale (19)(20)(21)(22), left ventricular (LV) dysfunction (23), pericardial effusion (24), and arrhythmias (25). For all of these sequelae, the first-line non-invasive cardiac imaging modality of choice remains to be echocardiography.…”

Section: Cardiac Involvement In Coronavirus Disease 2019mentioning

confidence: 99%

“…While the study by Li et al investigated RVLS strain (RVFWLS), it did not assess RV global longitudinal strain (RVGLS) or LV strain (36). A single-centre study subsequently analysed both parameters by 2-D STE in 100 consecutive hospitalised, COVID-19 patients comprising mild-to-severe disease (21). Strain analysis showed reduced LV global longitudinal strain (LVGLS) and RVFWLS in 42% and 38%, respectively, while LVEF was reduced in a smaller proportion (11%) of patients.…”

Section: Biventricular Involvementmentioning

confidence: 99%

Utility of Non-invasive Cardiac Imaging Assessment in Coronavirus Disease 2019

Hothi

Jiang

Steeds

et al. 2021

Front. Cardiovasc. Med.

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Coronavirus disease 2019 (COVID-19) was initially regarded as a disease of the lungs, which manifests as an acute respiratory illness and pneumonia, although more recently cardiac complications have been well-characterised. Serological cardiac biomarkers have been used to define acute myocardial injury, with significant elevation of high-sensitivity cardiac troponin (hs-cTn) associated with poor prognosis. Accordingly, 20–25% patients with acute myocardial injury (as defined by an elevated hs-cTn greater than the 99th percentile) have clinical signs of heart failure and increased mortality. An important outstanding clinical question is how best to determine the extent and nature of cardiac involvement in COVID-19. Non-invasive cardiac imaging has a well-established role in assessing cardiac structure and function in a wide range of cardiac diseases. It offers the potential to differentiate between direct and indirect COVID-19 effects upon the heart, providing incremental diagnostic and prognostic utility beyond the information yielded by elevated cardiac biomarkers in isolation. This review will focus on the non-invasive imaging assessment of cardiac involvement in COVID-19.

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The Predictive Role of Left and Right Ventricular Speckle-Tracking Echocardiography in COVID-19

Cited by 30 publications

References 5 publications

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

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

Sex Differences in the Incidence and Risk Factors of Myocardial Injury in COVID-19 Patients: A Retrospective Cohort Study

Utility of Non-invasive Cardiac Imaging Assessment in Coronavirus Disease 2019

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