Transthoracic Echocardiography-Based Prediction Model of Adverse Event Risk in Patients with COVID-19

Elena Zelikovna Golukhova; Inessa Viktorovna Slivneva; Maxim Leonidovich Mamalyga; Damir Ildarovich Marapov; Mikhail Nikolaevich Alekhin; Mikhail Mikhailovich Rybka; Irina Vasilevna Volkovskaya

doi:10.3390/pathophysiology29020014

Transthoracic Echocardiography-Based Prediction Model of Adverse Event Risk in Patients with COVID-19

Pathophysiology. 2022 Apr 26;29(2):157-172. doi: 10.3390/pathophysiology29020014.

Authors

Elena Zelikovna Golukhova¹, Inessa Viktorovna Slivneva², Maxim Leonidovich Mamalyga³, Damir Ildarovich Marapov⁴, Mikhail Nikolaevich Alekhin⁵, Mikhail Mikhailovich Rybka⁶, Irina Vasilevna Volkovskaya⁷

Affiliations

¹ A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
² Department of Emergency Ultrasound and Functional Diagnostics, A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
³ Department of Surgical Treatment of Coronary Heart Disease, A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
⁴ Department of Public Health, Economics and Health Care Management, Kazan State Medical Academy-Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian Federation, 420012 Kazan, Russia.
⁵ Functional Diagnostics Department of the Central Clinical Hospital with Polyclinic of the Russian Presidential Administration, 121359 Moscow, Russia.
⁶ Department of Anesthesiology and Intensive Care, A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
⁷ Polyclinic Department of the Institute of Coronary and Vascular Surgery, A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.

Abstract

Cardiopulmonary disorders cause a significant increase in the risk of adverse events in patients with COVID-19. Therefore, the development of new diagnostic and treatment methods for comorbid disorders in COVID-19 patients is one of the main public health challenges. The aim of the study was to analyze patient survival and to develop a predictive model of survival in adults with COVID-19 infection based on transthoracic echocardiography (TTE) parameters. We conducted a prospective, single-center, temporary hospital-based study of 110 patients with moderate to severe COVID-19. All patients underwent TTE evaluation. The predictors of mortality we identified in univariate and multivariable models and the predictive performance of the model were assessed using receiver operating characteristic (ROC) analysis and area under the curve (AUC). The predictive model included three factors: right ventricle (RV)/left ventricle (LV) area (odds ratio (OR) = 1.048 per 1/100 increase, p = 0.03), systolic pulmonary artery pressure (sPAP) (OR = 1.209 per 1 mm Hg increase, p < 0.001), and right ventricle free wall longitudinal strain (RV FW LS) (OR = 0.873 per 1% increase, p = 0.036). The AUC-ROC of the obtained model was 0.925 ± 0.031 (95% confidence interval (95% CI): 0.863−0.986). The sensitivity (Se) and specificity (Sp) measures of the models at the cut-off point of 0.129 were 93.8% and 81.9%, respectively. A binary logistic regression method resulted in the development of a prognostic model of mortality in patients with moderate and severe COVID-19 based on TTE data. It may also have additional implications for early risk stratification and clinical decision making in patients with COVID-19.

Keywords: COVID-19; TTE; multivariable model; predictive model; right ventricle free wall longitudinal strain; systolic pulmonary artery pressure; transthoracic echocardiography.