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Published on: December 19, 2020
Strain imaging as a prognostic indicator for complications in COVID-19 patients
Justin L Devera1, Choo P Wee2, Jina Sohn3
1Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA. justinlimdevera@gmail.com.
Insights
Right ventricular (RV) and left ventricular (LV) strain imaging can predict COVID-19 complications. Worsened RV strain is linked to acute respiratory distress syndrome (ARDS), offering valuable prognostic information for patients.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
Background:
- COVID-19 can lead to severe cardiopulmonary complications.
- Echocardiographic strain parameters may offer prognostic insights.
Purpose of the Study:
- To evaluate the predictive potential of right ventricular (RV) and left ventricular (LV) strain for COVID-19-related cardiopulmonary complications.
- To assess the association of RV and LV global longitudinal strain (GLS) with adverse outcomes post-COVID-19.
Main Methods:
- Retrospective analysis of 163 patients diagnosed with COVID-19.
- Transthoracic echocardiography with 2D speckle-tracking to measure RV GLS and LV GLS.
- Primary outcomes included death, pulmonary embolism, heart failure, ARDS, and others.
Main Results:
- Reduced mean RV GLS and LV GLS were observed in COVID-19 patients.
- 43.6% of patients experienced at least one primary outcome.
- Worsened RV GLS was significantly associated with the development of acute respiratory distress syndrome (ARDS) after adjustment.
Conclusions:
- Strain imaging, particularly RV GLS, provides incremental prognostic information in COVID-19 patients.
- RV GLS is a significant predictor of ARDS development.
- LV GLS associations with certain complications were not independent of other clinical factors.
Abstract:
The goal of this study was to determine the potential for right ventricular (RV) and left ventricular (LV) strain to predict cardiopulmonary complications of COVID-19. We identified 276 patients with COVID-19 who underwent transthoracic echocardiography within 30 days of COVID-19 diagnosis at our institution. Patients were excluded if they had a history of any primary outcomes before COVID-19 diagnosis or insufficient imaging. LV global longitudinal strain (GLS) and RV GLS were obtained using 2-dimensional speckle-tracking echocardiography. Primary outcomes were death, pulmonary embolism, congestive heart failure (CHF), cardiomyopathy, pulmonary fibrosis, pulmonary hypertension, acute respiratory distress syndrome (ARDS), and myocardial infarction (MI) occurring after COVID-19 diagnosis. In the final analysis of 163 patients, mean RV GLS and LV GLS were reduced, and 43.6% developed at least one primary outcome. There were significant differences in LV GLS distribution in terms of CHF, cardiomyopathy, and MI in bivariate analysis. However, LV GLS was not significantly associated with CHF after adjusting for LV ejection fraction and RV fractional area change, nor with MI after adjusting for troponin T. RV GLS was significantly associated with ARDS after adjusting for other variables. In the risk stratification of patients with COVID-19, strain imaging can provide incremental prognostic information, as worsened RV GLS is associated with the development of ARDS.
