Li Yuman, Fang Lingyun, Zhu Shuangshuang, Xie Yuji, Wang Bin, He Lin, Zhang Danqing, Zhang Yongxing, Yuan Hongliang, Wu Chun, Li He, Sun Wei, Zhang Yanting, Li Meng, Cui Li, Cai Yu, Wang Jing, Yang Yali, Lv Qing, Zhang Li, Johri Amer M, Xie Mingxing
Department of Ultrasound, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.
Front Cardiovasc Med. 2021 Mar 16;8:642973. doi: 10.3389/fcvm.2021.642973. eCollection 2021.
The cardiac manifestations of coronavirus disease 2019 (COVID-19) patients with cardiovascular disease (CVD) remain unclear. We aimed to investigate the prognostic value of echocardiographic parameters in patients with COVID-19 infection and underlying CVD. One hundred fifty-seven consecutive hospitalized COVID-19 patients were enrolled. The left ventricular (LV) and right ventricular (RV) structure and function were assessed using bedside echocardiography. Eighty-nine of the 157 patients (56.7%) had underlying CVD. Compared with patients without CVD, those with CVD had a higher mortality (22.5 vs. 4.4%, = 0.002) and experienced more clinical events including acute respiratory distress syndrome, acute heart injury, or deep vein thrombosis. CVD patients presented with poorer LV diastolic and RV systolic function compared to those without CVD. RV dysfunction (30.3%) was the most frequent, followed by LV diastolic dysfunction (9.0%) and LV systolic dysfunction (5.6%) in CVD patients. CVD patients with high-sensitivity troponin I (hs-TNI) elevation or requiring mechanical ventilation therapy demonstrated worsening RV function compared with those with normal hs-TNI or non-intubated patients, whereas LV systolic or diastolic function was similar. Impaired RV function was associated with elevated hs-TNI level. RV function and elevated hs-TNI level were independent predictors of higher mortality in COVID-19 patients with CVD. Patients with COVID-19 infection and underlying CVD displayed impaired LV diastolic and RV function, whereas LV systolic function was normal in most patients. Importantly, RV function parameters are predictive of higher mortality.
2019冠状病毒病（COVID-19）合并心血管疾病（CVD）患者的心脏表现仍不清楚。我们旨在研究超声心动图参数对COVID-19感染合并潜在CVD患者的预后价值。连续纳入157例住院的COVID-19患者。使用床旁超声心动图评估左心室（LV）和右心室（RV）的结构和功能。157例患者中有89例（56.7%）患有潜在的CVD。与无CVD的患者相比，患有CVD的患者死亡率更高（22.5%对4.4%，P = 0.002），并且经历了更多的临床事件，包括急性呼吸窘迫综合征、急性心脏损伤或深静脉血栓形成。与无CVD的患者相比，CVD患者的左心室舒张功能和右心室收缩功能较差。在CVD患者中，右心室功能障碍（30.3%）最为常见，其次是左心室舒张功能障碍（9.0%）和左心室收缩功能障碍（5.6%）。与高敏肌钙蛋白I（hs-TNI）正常或未插管的患者相比，hs-TNI升高或需要机械通气治疗的CVD患者右心室功能恶化，而左心室收缩或舒张功能相似。右心室功能受损与hs-TNI水平升高有关。右心室功能和hs-TNI水平升高是COVID-19合并CVD患者死亡率升高的独立预测因素。COVID-19感染合并潜在CVD的患者表现出左心室舒张功能和右心室功能受损，而大多数患者的左心室收缩功能正常。重要的是，右心室功能参数可预测更高的死亡率。
