Unmasking Myocardial Dysfunction in Patients Hospitalized for Community-Acquired Pneumonia Using a 4-Chamber...

Area of Science:

• Cardiology
• Pulmonology
• Medical Imaging

Background:

• Lower respiratory infections, particularly community-acquired pneumonia (CAP), are leading causes of infectious disease mortality.
• Myocardial injury is a known complication of CAP, but its prevalence and impact are likely underestimated.
• Assessing cardiac function in CAP patients is crucial for understanding disease severity and outcomes.

Purpose of the Study:

• To evaluate the rate and severity of myocardial dysfunction in patients diagnosed with community-acquired pneumonia (CAP).
• To utilize novel 3D echocardiography techniques for detailed cardiac chamber analysis in CAP.
• To correlate cardiac performance metrics with clinical and laboratory findings in CAP patients.

Main Methods:

• Prospective recruitment of hospitalized CAP patients.
• Performance of 2D/3D Doppler echocardiography within 24 hours of diagnosis.
• Blind analysis of 3D datasets for 4-chamber volumes and strains using specialized software.
• Correlation of echocardiographic parameters with clinical data, C-reactive protein (CRP), brain natriuretic peptide (BNP), and high-sensitivity cardiac troponin (hs-cTnl).

Main Results:

• 3D echocardiography revealed diffuse global myocardial dysfunction, notably in the atria and right ventricle (RVGLS = -8 ± 4%).
• Left ventricular global longitudinal strain (LVGLS) was normal ( -18 ± 5%) and correlated with BNP levels (r=0.40, p=0.024).
• Patients with worse LVGLS (> -17%) presented with higher blood pressure and lower oxygen saturation (SaO2).

Conclusions:

• Novel 3D echocardiography demonstrates significant, multi-chamber myocardial dysfunction in CAP patients.
• Worse left ventricular strain in CAP is associated with clinical indicators of disease severity (hypotension, hypoxia).
• LVGLS in CAP correlates with BNP but not with inflammatory or myocardial damage markers, suggesting a non-ischemic mechanism.