Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19.
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.
['Park|Jakob|J|', 'Kim|Yekaterina|Y|', 'Pereira|Jason|J|', 'Hennessey|Kerrilynn C|KC|', 'Faridi|Kamil F|KF|', 'McNamara|Robert L|RL|', 'Velazquez|Eric J|EJ|', 'Hur|David J|DJ|', 'Sugeng|Lissa|L|', 'Agarwal|Vratika|V|']
COVID-19 2D, Two-dimensional ARDS, acute respiratory distress syndrome 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