Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.
Echocardiography. 2021 Aug;38(8):1272-1281. doi: 10.1111/echo.15133. Epub 2021 Jun 29.
Whether the combination of ventricular strain with high-sensitivity troponin I (hs-TNI) has an incremental prognostic value in coronavirus disease 2019 (COVID-19) patients has not been evaluated. The study aimed to evaluate the prognostic value of biventricular longitudinal strain and its combination with hs-TNI in COVID-19 patients.
A total of 160 COVID-19 patients who underwent both echocardiography and hs-TNI testing were enrolled in our study. COVID-19 patients were divided into two groups (critical and non-critical) according to severity-of-illness. The clinical characteristics, cardiac structure and function were compared between the two groups. The prognostic value of biventricular longitudinal strain and its combination with hs-TNI were evaluated by logistic regression analyses and receiver operating characteristic curves. Left ventricular longitudinal strain (LV LS) and right ventricular free wall longitudinal strain (RVFWLS) were determined by 2D speckle-tracking echocardiography.
The LV LS and RVFWLS both were significantly lower in critical patients than non-critical patients (LV LS: -16.6±2.4 vs -17.9±3.0, P = .003; RVFWLS :-18.8±3.6 vs -23.9±4.4, P<.001). During a median follow-up of 60 days, 23 (14.4%) patients died. The multivariant analysis revealed that LV LS and RVFWLS [Odd ratio (95% confidence interval): 1.533 (1.131-2.079), P = .006; 1.267 (1.036-1.551), P = .021, respectively] were the independent predictors of higher mortality. Further, receiver-operating characteristic analysis revealed that the accuracy for predicting death was greater for the combination of hs-TNI levels with LV LS than separate LV LS (AUC: .91 vs .77, P = .001), and the combination of hs-TNI levels with RVFWLS than RVFWLS alone (AUC: .89 vs .83, P = .041).
Our study highlights that the combination of ventricular longitudinal strain with hs-TNI can provide higher accuracy for predicting mortality in COVID-19 patients, which may enhance risk stratification in COVID-19 patients.
尚不清楚心室应变与高敏肌钙蛋白 I（hs-TNI）联合检测对 2019 年冠状病毒病（COVID-19）患者是否具有额外的预后价值。本研究旨在评估 COVID-19 患者双心室纵向应变及其与 hs-TNI 联合检测的预后价值。
本研究共纳入 160 例接受超声心动图和 hs-TNI 检测的 COVID-19 患者。根据病情严重程度，将 COVID-19 患者分为两组（危急组和非危急组）。比较两组间的临床特征、心脏结构和功能。采用 logistic 回归分析和受试者工作特征曲线评估双心室纵向应变及其与 hs-TNI 联合检测的预后价值。左心室纵向应变（LV LS）和右心室游离壁纵向应变（RVFWLS）采用二维斑点追踪超声心动图检测。
危急组患者的 LV LS 和 RVFWLS 均显著低于非危急组（LV LS：-16.6±2.4 比-17.9±3.0，P=0.003；RVFWLS：-18.8±3.6 比-23.9±4.4，P<.001）。中位随访 60 天期间，23 例（14.4%）患者死亡。多变量分析显示，LV LS 和 RVFWLS [比值比（95%置信区间）：1.533（1.131-2.079），P=0.006；1.267（1.036-1.551），P=0.021]是死亡率较高的独立预测因素。进一步的受试者工作特征分析显示，hs-TNI 水平与 LV LS 联合检测预测死亡的准确性高于单独检测 LV LS（AUC：0.91 比 0.77，P=0.001），hs-TNI 水平与 RVFWLS 联合检测预测死亡的准确性高于单独检测 RVFWLS（AUC：0.89 比 0.83，P=0.041）。
本研究表明，心室纵向应变与 hs-TNI 联合检测可提高 COVID-19 患者死亡率预测的准确性，可能有助于 COVID-19 患者的风险分层。
