Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
JACC Cardiovasc Imaging. 2020 Nov;13(11):2287-2299. doi: 10.1016/j.jcmg.2020.04.014. Epub 2020 Apr 28.
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).
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.
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.
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%).
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.
本研究旨在探讨右心室纵向应变（RVLS）是否可独立预测 2019 年冠状病毒病（COVID-19）患者的死亡率更高。
二维斑点追踪超声心动图获得的 RVLS 最近已被证明是一种更准确和敏感的工具，可用于评估右心室（RV）功能。RVLS 在 COVID-19 患者中的预后价值尚不清楚。
本研究纳入了 120 例连续接受超声心动图检查的 COVID-19 患者。获得了常规 RV 功能参数，包括 RV 局部射血分数、三尖瓣环平面收缩期位移和三尖瓣组织多普勒瓣环速度。使用二维斑点追踪超声心动图测定 RVLS。根据 RVLS 将 RV 功能分为三分位。
与 RVLS 最高三分位的患者相比，最低三分位的患者更有可能具有更高的心率；更高水平的 D-二聚体和 C 反应蛋白；更高比例的高流量吸氧和有创机械通气治疗；更高的急性心脏损伤、急性呼吸窘迫综合征和深静脉血栓形成发生率；以及更高的死亡率。中位随访 51 天后，有 18 例患者死亡。与幸存者相比，非幸存者的右心腔增大，RV 功能降低，肺动脉收缩压升高。男性、急性呼吸窘迫综合征、RVLS、RV 局部射血分数和三尖瓣环平面收缩期位移是死亡率较高的显著单因素预测因素（p<0.05）。使用 RVLS（危险比：1.33；95%置信区间[CI]：1.15 至 1.53；p<0.001；Akaike 信息准则=129；C 指数=0.89）的 Cox 模型发现，与使用 RV 局部射血分数（Akaike 信息准则=142，C 指数=0.84）和三尖瓣环平面收缩期位移（Akaike 信息准则=144，C 指数=0.83）的模型相比，更能准确预测死亡率更高。RVLS 预测结局的最佳截断值为-23%（AUC：0.87；p<0.001；敏感性，94.4%；特异性，64.7%）。
RVLS 是 COVID-19 患者死亡率较高的有力预测因子。这些结果支持将 RVLS 应用于识别 COVID-19 高危患者。
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