Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19

Am Heart J Plus. 2021 Jun:6:100018. doi: 10.1016/j.ahjo.2021.100018. Epub 2021 Jun 1.

Abstract

Background: Coronavirus disease 2019 (COVID-19) can cause cardiac injury resulting in abnormal right or left ventricular function (RV/LV) with worse outcomes. We hypothesized that two-dimensional (2D) speckle-tracking assessment of LV global longitudinal strain (GLS) and RV free wall strain (FWS) by transthoracic echocardiography can assist as markers for subclinical cardiac injury predicting increased mortality.

Methods: We performed 2D strain analysis via proprietary software in 48 patients hospitalized with COVID-19. Clinical information, demographics, comorbidities, and lab values were collected via retrospective chart review. The primary outcome was in-hospital mortality based on an optimized abnormal LV GLS value via ROC analysis and RV FWS.

Results: The optimal LV GLS cutoff to predict death was -13.8%, with a sensitivity of 85% (95% CI 55-98%) and specificity of 54% (95% CI 36-71%). Abnormal LV GLS >-13.8% was associated with a higher risk of death [unadjusted hazard ratio 5.15 (95% CI 1.13-23.45), p = 0.034], which persisted after adjustment for clinical variables. Among patients with LV ejection fraction (LVEF) >50%, those with LV GLS > -13.8% had higher mortality compared to those with LV GLS <-13.8% (41% vs. 10%, p = 0.030). RV FWS value was higher in patients with LV GLS >-13.8% (-13.7 ± 5.9 vs. -19.6 ± 6.7, p = 0.003), but not associated with decreased survival.

Conclusion: Abnormal LV strain with a cutoff of >-13.8% in patients with COVID-19 is associated with significantly higher risk of death. Despite normal LVEF, abnormal LV GLS predicted worse outcomes in patients hospitalized with COVID-19. There was no mortality difference based on RV strain.

Keywords: 2D, Two-dimensional; ARDS, acute respiratory distress syndrome; COVID-19; COVID-19, Coronavirus Disease 2019; EF, ejection fraction; FAC, fractional area change; FWS, free wall strain; GLS, global longitudinal strain; HFrEF, heart failure reduced ejection fraction; Hs-TNT, high sensitivity troponin T; ICC, intra-class correlation coefficient; LV, left ventricle; Left ventricular strain; NT-proBNP, NT-pro-brain natriuretic peptide; RV, right ventricle; Speckle-tracking echocardiography; TTE, transthoracic echocardiography.