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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 JACC+Cardiovasc+Imaging
2020 ; 13
(11
): 2287-2299
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Prognostic Value of Right Ventricular Longitudinal Strain in Patients With
COVID-19
#MMPMID32654963
Li Y
; Li H
; Zhu S
; Xie Y
; Wang B
; He L
; Zhang D
; Zhang Y
; Yuan H
; Wu C
; Sun W
; Zhang Y
; Li M
; Cui L
; Cai Y
; Wang J
; Yang Y
; Lv Q
; Zhang L
; Xie M
JACC Cardiovasc Imaging
2020[Nov]; 13
(11
): 2287-2299
PMID32654963
show ga
OBJECTIVES: The aim of this study was to investigate whether right ventricular
longitudinal strain (RVLS) was independently predictive of higher mortality in
patients with coronavirus disease-2019 (COVID-19). BACKGROUND: RVLS obtained from
2-dimensional speckle-tracking echocardiography has been recently demonstrated to
be a more accurate and sensitive tool to estimate right ventricular (RV)
function. The prognostic value of RVLS in patients with COVID-19 remains unknown.
METHODS: One hundred twenty consecutive patients with COVID-19 who underwent
echocardiographic examinations were enrolled in our study. Conventional RV
functional parameters, including RV fractional area change, tricuspid annular
plane systolic excursion, and tricuspid tissue Doppler annular velocity, were
obtained. RVLS was determined using 2-dimensional speckle-tracking
echocardiography. RV function was categorized in tertiles of RVLS. RESULTS:
Compared with patients in the highest RVLS tertile, those in the lowest tertile
were more likely to have higher heart rate; elevated levels of D-dimer and
C-reactive protein; more high-flow oxygen and invasive mechanical ventilation
therapy; higher incidence of acute heart injury, acute respiratory distress
syndrome, and deep vein thrombosis; and higher mortality. After a median
follow-up period of 51 days, 18 patients died. Compared with survivors,
nonsurvivors displayed enlarged right heart chambers, diminished RV function, and
elevated pulmonary artery systolic pressure. Male sex, acute respiratory distress
syndrome, RVLS, RV fractional area change, and tricuspid annular plane systolic
excursion were significant univariate predictors of higher risk for mortality
(p < 0.05 for all). A Cox model using RVLS (hazard ratio: 1.33; 95% confidence
interval [CI]: 1.15 to 1.53; p < 0.001; Akaike information criterion = 129;
C-index = 0.89) was found to predict higher mortality more accurately than a
model with RV fractional area change (Akaike information criterion = 142,
C-index = 0.84) and tricuspid annular plane systolic excursion (Akaike
information criterion = 144, C-index = 0.83). The best cutoff value of RVLS for
prediction of outcome was -23% (AUC: 0.87; p < 0.001; sensitivity, 94.4%;
specificity, 64.7%). CONCLUSIONS: RVLS is a powerful predictor of higher
mortality in patients with COVID-19. These results support the application of
RVLS to identify higher risk patients with COVID-19.