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Echocardiographic parameters in COVID-19 patients and their association with ICU mortality: a prospective multicenter
Amarja Ashok Havaldar1, Merugu Vinay Kumar2, Raman Kumar3
1Department of Critical Care Medicine, St John's Medical College Hospital, 1st floor, MICU, Bangalore, 560034, India. amarjahavaldar@rediffmail.com.
Insights
Echocardiography revealed severe left ventricular systolic dysfunction is linked to higher ICU mortality in COVID-19 patients. Lower e
Area of Science:
- Critical Care Medicine
- Cardiology
- Infectious Diseases
Background:
- Echocardiography is crucial for managing critically ill patients, aiding in diagnosing and treating various conditions.
- COVID-19 can lead to cardiac dysfunction, necessitating studies on echocardiographic parameters in affected patients.
Purpose of the Study:
- To investigate echocardiographic parameters in intensive care unit (ICU) patients with COVID-19 pneumonia.
- To determine the association between echocardiographic findings and ICU mortality, length of ICU stay, and duration of mechanical ventilation.
Main Methods:
- A prospective, observational, multicenter study enrolled 573 COVID-19 pneumonia patients admitted to the ICU.
- Echocardiographic evaluations, including left and right heart function and left ventricular diastolic function, were performed within 24-48 hours of admission.
- Primary outcome was ICU mortality; secondary outcomes included ICU stay duration and mechanical ventilation duration.
Main Results:
- Severe left ventricle (LV) systolic dysfunction was observed in 8.7% of patients and was associated with increased odds of mortality (OR 2.48, p=0.037).
- Lower e' (a measure of diastolic function) was also associated with higher mortality (OR 0.897, p=0.046).
- E/e' ratio, indicative of LV filling pressure, was not found to be significant; Troponin I, E/A ratio, and right ventricular (RV) dilatation were similar between survivors and non-survivors.
Conclusions:
- Severe LV systolic dysfunction identified via echocardiography is a significant predictor of ICU mortality in COVID-19 patients.
- While E/e' was not significant, lower e' values correlate with increased mortality risk.
- Echocardiography provides valuable prognostic information for critically ill COVID-19 patients.
Background:
Echocardiography has become an integral part of the management of critically ill patients. It helps to diagnose and treat various conditions. COVID-19 patients can develop cardiac dysfunction. We planned to study the echocardiographic parameters in COVID-19 patients.
Methods:
We conducted a prospective observational multicenter study after institutional ethical committee approval. COVID-19 pneumonia patients admitted to the intensive care unit (ICU) were enrolled. The echocardiographic evaluation was done within 24-48 hours of admission. Assessment of the left and right heart with systolic and left ventricular diastolic function evaluation was done. The primary outcome was ICU mortality. The secondary outcomes were the length of ICU stay and duration of mechanical ventilation.
Results:
Among 573 patients mean age was 57.17 (14.67) with 68.60% being males. On day 1 of ICU, invasive mechanical ventilation was used in 257 (45%) patients. One hundred and forty-eight (25.83%) patients were on vasopressors when echocardiography was performed. Severe left ventricle (LV) systolic dysfunction was seen in 8.7% of patients and had higher odds of mortality [2.48(1.058-5.807), p = 0.037] followed by E and e' with odds ratio of [0.984(0.971-0.998), p = 0.021] and 0.897 (0.805-0.998), p = 0.046], respectively. E/e' indicative of filling pressure of the LV was not found to be significant. Troponin I, E/A, and RV dilatation were similar among survivors and non-survivors.
Conclusion:
Echocardiographic evaluation in COVID-19 patients showed severe LV systolic dysfunction was associated with ICU mortality. E/e' was not found to be significant but lower e' was associated with higher mortality. Trial registration IEC 131/2020, CTRI/2020/06/025858 date 13th June 2020.
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