Biventricular Longitudinal Strain Predict Mortality in COVID-19 Patients

Yuji Xie; Lufang Wang; Meng Li; He Li; Shuangshuang Zhu; Bin Wang; Lin He; Danqing Zhang; Yongxing Zhang; Hongliang Yuan; Chun Wu; Wei Sun; Yanting Zhang; Li Cui; Yu Cai; Jing Wang; Yali Yang; Qing Lv; Mingxing Xie; Yuman Li; Li Zhang

doi:10.3389/fcvm.2020.632434

Biventricular Longitudinal Strain Predict Mortality in COVID-19 Patients

Front Cardiovasc Med. 2021 Jan 18:7:632434. doi: 10.3389/fcvm.2020.632434. eCollection 2020.

Authors

Yuji Xie^{1

2}, Lufang Wang^{1

2}, Meng Li^{1

2}, He Li^{1

2}, Shuangshuang Zhu^{1

2}, Bin Wang^{1

2}, Lin He^{1

2}, Danqing Zhang^{1

2}, Yongxing Zhang^{1

2}, Hongliang Yuan^{1

2}, Chun Wu^{1

2}, Wei Sun^{1

2}, Yanting Zhang^{1

2}, Li Cui^{1

2}, Yu Cai^{1

2}, Jing Wang^{1

2}, Yali Yang^{1

2}, Qing Lv^{1

2}, Mingxing Xie^{1

2}, Yuman Li^{1

2}, Li Zhang^{1

2}

Affiliations

¹ Department of Ultrasound, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
² Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.

Abstract

Background: Biventricular longitudinal strain has been recently demonstrated to be predictive of poor outcomes in various cardiovascular settings. Therefore, this study sought to investigate the prognostic implications of biventricular longitudinal strain in patients with coronavirus disease 2019 (COVID-19). Methods: We enrolled 132 consecutive patients with COVID-19. Left ventricular global longitudinal strain from the apical four-chamber views (LV GLS_4CH) and right ventricular free wall longitudinal strain (RV FWLS) were obtained using two-dimensional speckle-tracking echocardiography. Results: Compared with patients without cardiac injury, those with cardiac injury had higher levels of coagulopathy and inflammatory biomarkers, higher incidence of complications, more mechanical ventilation therapy, and higher mortality. Patients with cardiac injury displayed decreased LV GLS_4CH and RV FWLS, elevated pulmonary artery systolic pressure, and higher proportion of pericardial effusion. Higher biomarkers levels of inflammation and cardiac injury, and the presence of pericardial effusion were correlated with decreases in LV GLS_4CH and RV FWLS. During hospitalization, 19 patients died. Compared with survivors, LV GLS_4CH and RV FWLS were impaired in non-survivors. At a 3-month follow-up after discharge, significant improvements were observed in LV GLS_4CH and RV FWLS. Multivariate Cox analysis revealed that LV GLS_4CH [hazard ratio: 1.41; 95% confidence interval [CI]: 1.08 to 1.84; P = 0.011] and RV FWLS (HR: 1.29; 95% CI: 1.09-1.52; P = 0.003) were independent predictors of higher mortality in patients with COVID-19. Conclusions: LV GLS_4CH and RV FWLS are independent and strong predictors of higher mortality in COVID-19 patients and can track improvement during the convalescent phase of their illness. Therefore, biventricular longitudinal strain may be crucial for risk stratification and serial follow-up in patients with COVID-19.

Keywords: COVID-19; left ventricular function; right ventricular function; speckle tracking echocardiography; strain.