Right ventricular longitudinal strain may predict mortality in COVID-19
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Right ventricular longitudinal strain predicted higher mortality in patients with COVID-19, according to a study published in JACC: Cardiovascular Imaging.
“To the best of our knowledge, there are no data regarding the use of right ventricular longitudinal strain in patients with COVID-19,” Mingxing Xie, MD, PhD, FAHA, FASE, professor and chief, department of ultrasound, Union Hospital at Huazhong University of Science and Technology Tongji Medical College in Wuhan, China, told Healio. “Our results demonstrated that right ventricular longitudinal strain is an independent and powerful determinant of higher mortality in patients with COVID-19. Importantly, this index provides the greater predictive value over other echocardiographic parameters. Therefore, evaluation of RV function should be implemented by investigation of right ventricular longitudinal strain for risk stratification in patients with COVID-19.”
RV parameters
Researchers analyzed data from 120 patients (mean age, 61 years; 48% men) with COVID-19 from Union Hospital in Wuhan, China. All patients underwent bedside echocardiography to assess conventional right ventricular (RV) function parameters, including tricuspid annular plane systolic excursion, RV fractional area change and tricuspid tissue Doppler annual velocities. The researchers used two-dimensional speckle-tracking echocardiography to determine RV longitudinal strain.
Patients in the lowest tertile of RV longitudinal strain were more likely to have higher D-dimer level, faster heart rate, higher C-reactive protein level, greater need for invasive mechanical ventilation therapy and greater need for high-flow oxygen therapy compared with those in the highest tertile of RV longitudinal strain. In addition, these patients were more likely to have higher incidence of acute heart injury, mortality, deep vein thrombosis and acute respiratory distress syndrome.
Eighteen patients died during a median follow-up of 51 days. Patients who did not survive had diminished RV function, enlarged right heart chamber and elevated pulmonary artery systolic pressure compared with those who survived.
Significant univariate predictors of higher risk for mortality included acute respiratory distress syndrome (ARDS; HR = 10.31; 95% CI, 2.98-35.63), male sex (HR = 4.49; 95% CI, 1.48-13.66), RV fractional area change (HR = 0.88; 95% CI, 0.81-0.95), RV longitudinal strain (HR = 1.45; 95% CI, 1.26-1.67) and tricuspid annular plane systolic excursion (HR = 0.86; 95% CI, 0.76-0.97).
Researchers also performed a multivariate Cox analysis, which found that RV longitudinal strain predicted higher risk for mortality (HR = 1.33; 95% CI, 1.15-1.53), as did ARDS (HR = 4.47; 95% CI, 1.25-16.33), RV fractional area change (HR = 0.9; 95% CI, 0.83-0.98) and tricuspid annular plane systolic excursion (HR = 0.88; 95% CI, 0.78-0.99).
A model with RV longitudinal strain (C-index, 0.89) was better at predicting mortality than one with RV fractional area change (C-index, 0.84), one with tricuspid annular plane systolic excursion (C-index, 0.83) and a traditional risk model (C-index, 0.82), according to the researchers.
The ideal cutoff value for RV longitudinal strain to detect increased risk for mortality was 23% (area under the curve, 0.87; P < .001; specificity, 64.7%; sensitivity, 94.4%).
Further research
“Confirming the role of right ventricular longitudinal strain in these patients may be of additional significance, as most cases exhibit the preserved conventional echocardiographic parameters, among whom detection and risk stratification may be challenging,” Xie said in an interview. “This suggests that evaluation of right ventricular function by conventional echocardiography measurements (ie, fractional area change or tricuspid annular plane systolic excursion) need to be complemented by right ventricular longitudinal strain analysis to identify patients at higher risk of poor outcome.” – by Darlene Dobkowski
For more information:
Mingxing Xie, MD, PhD, FAHA, FASE, can be reached at xiemx@hust.edu.cn.
Disclosures: The authors report no relevant financial disclosures.
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