Relation of myocardial dysfunction to biomarkers, COVID-19 severity and all-cause mortality
Jianxiong Chen1,2, Lin Jin3, Mengjiao Zhang4
1Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.
Insights
COVID-19 can cause heart muscle injury. This study found that reduced global circumferential strain (GCS) in COVID-19 patients is linked to a higher risk of death.
Area of Science:
- Cardiology
- Infectious Diseases
- Echocardiography
Background:
- COVID-19 infection is associated with myocardial injury.
- The relationship between left ventricular strain parameters (GLS, GCS, GRS), disease severity, and mortality in COVID-19 patients requires clarification.
Purpose of the Study:
- To investigate the association between left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) with COVID-19 severity and all-cause mortality.
Main Methods:
- Utilized two-dimensional speckle-tracking echocardiography to analyze GLS, GCS, and GRS in 220 COVID-19 patients.
- Assessed associations between strain parameters, cardiac biomarkers (BUN, cTnI), and all-cause mortality using Cox regression and Kaplan-Meier curves.
- Followed patients for an average of 11 days, with 19 reaching the endpoint (death).
Main Results:
- Significant associations were found between all three strain parameters and blood urea nitrogen (BUN) levels.
- Cardiac troponin I (cTnI) levels correlated with GLS and GCS.
- A GCS greater than -21.6% was significantly associated with an increased risk of all-cause death (Hazard Ratio: 4.007).
Conclusions:
- Left ventricular GLS, GCS, and GRS are significantly related to myocardial dysfunction in COVID-19 patients.
- Worsening GCS is a key indicator of increased mortality risk in COVID-19 survivors.
Aims:
The COVID-19 infection has been described as affecting myocardial injury. However, the relation between left ventricular global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), disease severity and all-cause mortality in COVID-19 is unclear.
Methods And Results:
The study consisted of 220 patients with COVID-19, including 127 (57.5%) with mild, 43 (19.5%) with moderate and 50 (22.7%) with severe/critical conditions. Myocardial dysfunction was analysed by GLS, GCS and GRS using two-dimensional speckle-tracking echocardiography. Hazard ratios and Kaplan-Meier curves were produced to assess the association between strains and cardiac biomarker indices with a composite outcome of all-cause mortality. With an average follow-up period of 11 days, 19 patients reached the endpoint (death). Significant associations were found for the three strain parameters and the levels of blood urea nitrogen (BUN) (r = 0.206, 0.221 and 0.355, respectively). Cardiac troponin I (cTnI) was closely related to the GLS and GCS (r = 0.240 and 0.324, respectively). In multivariable Cox regression, GCS > -21.6% was associated with all-cause death {hazard ratio, 4.007 [95% confidence interval (CI), 11.347-11.919]}.
Conclusions:
GLS, GCS and GRS are significantly related to myocardial dysfunction in patients with COVID-19. Worsening GCS poses an increased risk of death in COVID-19.
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