LV global longitudinal strain may predict poor outcomes in COVID-19
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Left ventricular global longitudinal strain predicted death and respiratory failure in patients hospitalized with COVID-19, researchers reported in the American Journal of Cardiology.
Michele Bevilacqua, MD, internal medicine resident at University Hospital of Verona, Italy, and colleagues analyzed 87 patients with COVID-19 admitted to University Hospital of Verona who had a complete echocardiography examination within 72 hours of admission.
The primary outcome, mechanical ventilation by orotracheal intubation and/or mortality, occurred in 14 patients, whereas the secondary outcome, severe acute respiratory distress syndrome, defined as worsening respiratory function as indicated by a partial pressure of oxygen to fraction of inspired oxygen ratio of less than 100, occurred in 24 patients, the researchers wrote.
After the researchers adjusted for risk factors and considered LV global longitudinal strain as a continuous variable, they found LV global longitudinal strain was associated with the secondary outcome (adjusted HR = 1.48; 95% CI, 1.18-1.88; P = .001) and the primary outcome (aHR = 1.63; 95% CI, 1.13-2.38; P = .012).
Having LV global longitudinal strain of at least –16.1% was independently associated with risk for severe acute respiratory distress syndrome (HR = 4; 95% CI, 1.4-11.1; P = .008) and death or orotracheal intubation (HR = 7.3; 95% CI, 1.6-34.1; P = .024), according to the researchers.
“LV global longitudinal strain measured at the moment of admission was a strong predictor of respiratory failure and mortality,” Bevilacqua and colleagues wrote. “Although troponin is a good biomarker of myocardial injury, in our study troponin was not a predictor of mortality.
Thus, it remains to be determined whether SARS-CoV-2 affects the myocardium directly or the cardiac impairment is related to the systemic consequences of COVID-19. It has been demonstrated that systemic inflammation increases the metabolic demand, leading to cardiac stress. Our findings suggest that cardiac damage is preferentially associated with LV longitudinal fibers dysfunction because of the inflammatory process, rather than ischemic stress.”
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