Buckinghamshire Healthcare NHS Foundation Trust, High Wycombe, UK.
Echocardiography. 2021 Feb;38(2):222-229. doi: 10.1111/echo.14966. Epub 2020 Dec 24.
The aim of this investigation was to evaluate echocardiographic parameters of cardiac function and in particular right ventricular (RV) function as a predictor of mortality in patients with coronavirus disease-2019 (COVID-19) pneumonia.
This prospective observational study included 35 patients admitted to a UK district general hospital with COVID-19 and evidence of cardiac involvement, that is, raised Troponin I levels or clinical evidence of heart failure during the first wave of the COVID-19 pandemic (March-May 2020). All patients underwent echocardiography including speckle tracking for right ventricular longitudinal strain (RVLS) providing image quality was sufficient (30 out of 35 patients). Upon comparison of patients who survived COVID-19 with non-survivors, survivors had significantly smaller RVs (basal RV diameter 38.2 vs 43.5 mm P = .0295) with significantly better RV function (Tricuspid annular plane systolic excursion (TAPSE): 17.5 vs 15.3 mm P = .049; average RVLS: 24.3% vs 15.6%; P = .0018). Tricuspid regurgitation (TR) maximal velocity was higher in survivors (2.75 m/s vs 2.11 m/s; P = .0045) indicating that pressure overload was not the predominant driver of this effect and there was no significant difference in left ventricular (LV) ejection fraction. Kaplan-Meier and log-rank analysis of patients split into groups according to average RVLS above or below 20% revealed significantly increased 30-day mortality in patients with average RVLS under 20% (HR: 3.189; 95% CI: 1.297-12.91; P = .0195).
This study confirms that RVLS is a potent and independent predictor of outcome in COVID-19 patients with evidence of cardiac involvement.
本研究旨在评估超声心动图心功能参数，特别是右心室（RV）功能，作为 2019 年冠状病毒病（COVID-19）肺炎患者死亡率的预测指标。
这项前瞻性观察研究纳入了 35 名因 COVID-19 而入住英国地区综合医院并伴有心脏受累证据的患者，即肌钙蛋白 I 水平升高或 COVID-19 大流行第一波期间（2020 年 3 月至 5 月）有心力衰竭的临床证据。所有患者均接受了超声心动图检查，包括斑点追踪技术评估右心室纵向应变（RVLS），图像质量足够的患者（35 例中有 30 例）进行了此项检查。与 COVID-19 幸存者相比，非幸存者的 RV 更小（基底 RV 直径 38.2 毫米对 43.5 毫米，P=0.0295），RV 功能更好（三尖瓣环平面收缩期位移（TAPSE）：17.5 毫米对 15.3 毫米，P=0.049；平均 RVLS：24.3%对 15.6%，P=0.0018）。幸存者的三尖瓣反流（TR）最大速度更高（2.75 米/秒对 2.11 米/秒，P=0.0045），这表明压力超负荷并不是造成这种影响的主要原因，左心室（LV）射血分数无显著差异。根据平均 RVLS 高于或低于 20%将患者分为两组，进行 Kaplan-Meier 和对数秩分析显示，平均 RVLS 低于 20%的患者 30 天死亡率显著升高（HR：3.189；95%CI：1.297-12.91；P=0.0195）。
本研究证实，RVLS 是 COVID-19 伴有心脏受累证据患者预后的有力且独立的预测指标。
