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A pilot study on right ventricular longitudinal strain as a predictor of outcome in COVID‐19 patients with evidence of cardiac involvement
Author(s) -
Stockenhuber Alexander,
Vrettos Apostolos,
Androshchuk Vitaliy,
George Manju,
Robertson Calum,
Bowers Nicola,
Clifford Piers,
Firoozan Soroosh
Publication year - 2021
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14966
Subject(s) - medicine , cardiology , ejection fraction , covid-19 , speckle tracking echocardiography , cardiac function curve , heart failure , disease , infectious disease (medical specialty)
Abstract Aims The aim of this investigation was to evaluate echocardiographic parameters of cardiac function and in particular right ventricular (RV) function as a predictor of mortality in patients with coronavirus disease‐2019 (COVID‐19) pneumonia. Methods and Results This prospective observational study included 35 patients admitted to a UK district general hospital with COVID‐19 and evidence of cardiac involvement, that is, raised Troponin I levels or clinical evidence of heart failure during the first wave of the COVID‐19 pandemic (March–May 2020). All patients underwent echocardiography including speckle tracking for right ventricular longitudinal strain (RVLS) providing image quality was sufficient (30 out of 35 patients). Upon comparison of patients who survived COVID‐19 with non‐survivors, survivors had significantly smaller RVs (basal RV diameter 38.2 vs 43.5 mm P = .0295) with significantly better RV function (Tricuspid annular plane systolic excursion (TAPSE): 17.5 vs 15.3 mm P = .049; average RVLS: 24.3% vs 15.6%; P = .0018). Tricuspid regurgitation (TR) maximal velocity was higher in survivors (2.75 m/s vs 2.11 m/s; P = .0045) indicating that pressure overload was not the predominant driver of this effect and there was no significant difference in left ventricular (LV) ejection fraction. Kaplan–Meier and log‐rank analysis of patients split into groups according to average RVLS above or below 20% revealed significantly increased 30‐day mortality in patients with average RVLS under 20% (HR: 3.189; 95% CI: 1.297–12.91; P = .0195). Conclusion This study confirms that RVLS is a potent and independent predictor of outcome in COVID‐19 patients with evidence of cardiac involvement.