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Published on: April 18, 2025
Bedside echocardiography to predict mortality of COVID-19 patients beyond clinical data: Data from the PROVAR-COVID
Sander Luis Gomes Pimentel1, Bruno Ramos Nascimento1,2, Juliane Franco1
1Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil.
Insights
Bedside echocardiography revealed that right and left ventricular dysfunction are key predictors of mortality in hospitalized COVID-19 patients. These cardiac markers, alongside age, independently forecast survival outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiac involvement is a significant factor influencing prognosis in COVID-19 patients, particularly those critically ill.
- Right ventricular (RV) and left ventricular (LV) dysfunction are potential indicators of poor outcomes in COVID-19.
Purpose of the Study:
- To evaluate the prognostic value of RV and LV dysfunction, assessed via bedside echocardiography (echo), in hospitalized COVID-19 patients.
- To identify independent predictors of in-hospital mortality in this patient cohort.
Main Methods:
- 163 hospitalized COVID-19 patients with moderate to severe presentations underwent clinical, laboratory, and focused bedside echocardiography.
- Association between demographic, clinical, and echocardiographic variables with all-cause hospital mortality was analyzed using univariate and multivariable models.
Main Results:
- In-hospital mortality was 34%. Significant univariate predictors of death included LV ejection fraction (LVEF), RV fractional area change, tricuspid annular plane systolic excursion (TAPSE), and RV dysfunction.
- Multivariable analysis identified age ≥63 years, LVEF <64%, and TAPSE <18.5 mm as independent predictors of mortality.
- The final predictive model demonstrated good discrimination (C-statistic=0.83).
Conclusions:
- Bedside echocardiography-derived markers of RV and LV dysfunction are independent predictors of mortality in hospitalized COVID-19 patients.
- These echocardiographic findings provide valuable prognostic information beyond traditional clinical variables.
Introduction:
Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19.
Methods:
Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models.
Results:
Total 163 patients were enrolled, 59% were men, mean age 64±16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91).
Conclusion:
Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.
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