Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan.
J Med Ultrason (2001). 2023 Jul;50(3):417-425. doi: 10.1007/s10396-023-01305-y. Epub 2023 Apr 20.
The purpose of this study was to evaluate and confirm the prognostic utility of comprehensive transthoracic echocardiography (TTE) using offline myocardial strain analyses in a Japanese coronavirus disease (COVID-19) cohort hospitalized in intensive care units.
We performed a retrospective analysis of 90 consecutive adult patients with COVID-19 who underwent clinically indicated standard two-dimensional TTE in intensive care wards. Patients on extracorporeal membrane oxygenation (ECMO) at the time of TTE were excluded. Biventricular strain assessments using vendor-independent offline speckle tracking analysis were performed. Patients with inadequate TTE image quality were also excluded.
Among the 90 COVID-19 patients, 15 (17%) patients required venovenous or venoarterial ECMO. There were 25 (28%) in-hospital deaths. A composite event, defined as the combination of in-hospital mortality and subsequent initiation of ECMO, occurred in 32 patients. Multivariate logistic regression for composite events indicated that right ventricular free wall longitudinal strain (RV-FWLS) and mechanical ventilation at the time of TTE were independent risk factors for composite events (p = 0.01, odds ratio [OR] 1.09, 95% confidence interval [CI] 1.01-1.18; p = 0.04, OR 3.24, 95% CI 1.03-10.20). Cumulative survival probability plots generated using the Kaplan-Meier method for composite events with log-rank tests revealed a significant difference between subgroups divided by the cutoff value of RV-FWLS (p < 0.001).
Offline measurement of RV-FWLS may be a potent predictor of worse outcomes in COVID-19 requiring intensive care. Larger multicenter prospective studies are needed.
本研究旨在评估和确认综合经胸超声心动图（TTE）使用离线心肌应变分析在日本冠状病毒病（COVID-19）重症监护病房住院患者中的预后效用。
我们对 90 例连续的 COVID-19 成年患者进行了回顾性分析，这些患者在重症监护病房进行了临床指示的标准二维 TTE。在 TTE 时接受体外膜肺氧合（ECMO）的患者被排除在外。使用与供应商无关的离线斑点追踪分析进行双心室应变评估。也排除了 TTE 图像质量不足的患者。
在 90 例 COVID-19 患者中，有 15 例（17%）患者需要静脉-静脉或静脉-动脉 ECMO。有 25 例（28%）住院死亡。复合事件定义为住院死亡率和随后开始 ECMO 的组合，在 32 例患者中发生。复合事件的多变量逻辑回归表明，右心室游离壁纵向应变（RV-FWLS）和 TTE 时的机械通气是复合事件的独立危险因素（p=0.01，优势比[OR]1.09，95%置信区间[CI]1.01-1.18；p=0.04，OR 3.24，95% CI 1.03-10.20）。使用 Kaplan-Meier 方法生成的复合事件累积生存概率图，并进行对数秩检验，发现 RV-FWLS 截断值分组的亚组之间存在显著差异（p<0.001）。
离线测量 RV-FWLS 可能是 COVID-19 需要重症监护的患者预后不良的有力预测指标。需要更大的多中心前瞻性研究。
