Lanspa Michael J, Dugar Siddharth P, Prigmore Heather L, Boyd Jeremy S, Rupp Jordan D, Lindsell Chris J, Rice Todd W, Qadir Nida, Lim George W, Shiloh Ariel L, Dieiev Vladyslav, Gong Michelle N, Fox Steven W, Hirshberg Eliotte L, Khan Akram, Kornfield James, Schoeneck Jacob H, Macklin Nicholas, Files D Clark, Gibbs Kevin W, Prekker Matthew E, Parsons-Moss Daniel, Bown Mikaele, Olsen Troy D, Knox Daniel B, Cirulis Meghan M, Mehkri Omar, Duggal Abhijit, Tenforde Mark W, Patel Manish M, Self Wesley H, Brown Samuel M
Shock Trauma ICU, Intermountain Medical Center, Salt Lake City, UT.
Cleveland Clinic, Cleveland, OH.
CHEST Crit Care. 2023 Jun;1(1):100002. doi: 10.1016/j.chstcc.2023.100002. Epub 2023 Mar 22.
Cardiac function of critically ill patients with COVID-19 generally has been reported from clinically obtained data. Echocardiographic deformation imaging can identify ventricular dysfunction missed by traditional echocardiographic assessment.
What is the prevalence of ventricular dysfunction and what are its implications for the natural history of critical COVID-19?
This is a multicenter prospective cohort of critically ill patients with COVID-19. We performed serial echocardiography and lower extremity vascular ultrasound on hospitalization days 1, 3, and 8. We defined left ventricular (LV) dysfunction as the absolute value of longitudinal strain of < 17% or left ventricle ejection fraction (LVEF) of < 50%. Primary clinical outcome was inpatient survival.
We enrolled 110 patients. Thirty-nine (35.5%) died before hospital discharge. LV dysfunction was present at admission in 38 patients (34.5%) and in 21 patients (36.2%) on day 8 ( = .59). Median baseline LVEF was 62% (interquartile range [IQR], 52%-69%), whereas median absolute value of baseline LV strain was 16% (IQR, 14%-19%). Survivors and nonsurvivors did not differ statistically significantly with respect to day 1 LV strain (17.9% vs 14.4%; = .12) or day 1 LVEF (60.5% vs 65%; = .06). Nonsurvivors showed worse day 1 right ventricle (RV) strain than survivors (16.3% vs 21.2%; = .04).
Among patients with critical COVID-19, LV and RV dysfunction is common, frequently identified only through deformation imaging, and early (day 1) RV dysfunction may be associated with clinical outcome.
关于新型冠状病毒肺炎（COVID-19）危重症患者的心脏功能，一般是根据临床获取的数据进行报告。超声心动图变形成像能够识别传统超声心动图评估遗漏的心室功能障碍。
心室功能障碍的患病率是多少，其对危重症COVID-19的自然病程有何影响？
这是一项针对COVID-19危重症患者的多中心前瞻性队列研究。我们在住院第1天、第3天和第8天进行了系列超声心动图检查及下肢血管超声检查。我们将左心室（LV）功能障碍定义为纵向应变绝对值<17%或左心室射血分数（LVEF）<50%。主要临床结局为住院期间生存率。
我们纳入了110例患者。39例（35.5%）在出院前死亡。38例患者（34.5%）入院时存在LV功能障碍，第8天有21例患者（36.2%）存在LV功能障碍（P = 0.59）。基线LVEF中位数为62%（四分位间距[IQR]，52% - 69%），而基线LV应变绝对值中位数为16%（IQR，14% - 19%）。就第1天的LV应变（17.9%对14.4%；P = 0.12）或第1天的LVEF（60.5%对65%；P = 0.06）而言，幸存者和非幸存者在统计学上无显著差异。非幸存者第1天的右心室（RV）应变比幸存者更差（16.3%对21.2%；P = 0.04）。
在危重症COVID-19患者中，LV和RV功能障碍很常见，常仅通过变形成像才能识别，且早期（第1天）RV功能障碍可能与临床结局相关。
