Liu Yingxian, Xie Jinjie, Gao Peng, Tian Ran, Qian Hao, Guo Fan, Yan Xiaowei, Song Yanjun, Chen Wei, Fang Ligang, Wu Wei, Zhang Shuyang
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Beijing, 100730, China.
Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
ESC Heart Fail. 2020 Dec;7(6):3621-3632. doi: 10.1002/ehf2.12873. Epub 2020 Sep 25.
Cardiac complications are common and associated with mortality in critically ill patients with COVID-19; however, the diagnostic and prognostic implications of critical care echocardiography (CCE) have not been studied.
A cohort of 43 patients with COVID-19 who were in the intensive care unit (ICU) underwent bedside CCE during their disease course. Demographic, clinical, and survival data were collected. The echocardiographic analyses revealed high frequencies of pericardial effusion (90.7%), increased left ventricular mass index (60.5%), elevated relative wall thickness (76.7%), and reduced left ventricular stroke volume index (LVSVi; 53.5%) and cardiac index (51.2%). Twenty-two (51.2%) patients died in the ICU. In multivariate Cox regression, the strongest predictor of in-ICU death was decreased cardiac index [hazard ratio (HR), 0.67, 95% confidence interval (CI), 0.45-0.98; P = 0.041], after adjusting for male sex, shock status, high-sensitivity cardiac troponin I, and N-terminal pro-B-type natriuretic peptide. Negative associations with mortality were observed for LVSVi (HR, 0.91, 95% CI 0.85-0.96; P = 0.002), tricuspid annular plane systolic excursion (HR, 0.74, 95% CI 0.64-0.84; P < 0.001), and S' (HR, 0.78, 95% CI 0.69-0.88; P < 0.001). Kaplan-Meier analyses indicated that reductions in LVSVi, cardiac index, TAPSE, and S' were associated with a shorter survival time.
Pericardial effusion and increased ventricular mass in COVID-19 might indicate a swollen heart. Both left and right heart dysfunction and a reduced cardiac index may lead to an increased risk of mortality. Clinicians should pay special attention to cardiac haemodynamic disorders in critical patients with COVID-19.
心脏并发症在新型冠状病毒肺炎（COVID-19）危重症患者中很常见，且与死亡率相关；然而，重症超声心动图（CCE）的诊断和预后意义尚未得到研究。
对43例入住重症监护病房（ICU）的COVID-19患者在病程中进行了床旁CCE检查。收集了人口统计学、临床和生存数据。超声心动图分析显示心包积液发生率高（90.7%）、左心室质量指数增加（60.5%）、相对室壁厚度升高（76.7%）、左心室每搏输出量指数（LVSVi；53.5%）和心脏指数降低（51.2%）。22例（51.2%）患者在ICU死亡。在多因素Cox回归分析中，在校正了男性、休克状态、高敏心肌肌钙蛋白I和N末端B型利钠肽原后，最强的ICU内死亡预测因素是心脏指数降低[风险比（HR），0.67，95%置信区间（CI），0.45 - 0.98；P = 0.041]。观察到LVSVi（HR，0.91，95% CI 0.85 - 0.96；P = 0.002）、三尖瓣环平面收缩期位移（HR，0.74，95% CI 0.64 - 0.84；P < 0.001）和S'（HR，0.78，95% CI 0.69 - 0.88；P < 0.001）与死亡率呈负相关。Kaplan-Meier分析表明，LVSVi、心脏指数、三尖瓣环平面收缩期位移和S'降低与生存时间缩短相关。
COVID-19患者的心包积液和心室质量增加可能提示心脏肿大。左右心功能不全和心脏指数降低均可能导致死亡风险增加。临床医生应特别关注COVID-19危重症患者的心功能血流动力学紊乱。
