van Blydenstein S A, Omar S, Jacobson B, Menezes C N, Meel R
Division of Pulmonology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa.
Division of Critical Care, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa.
Eur Heart J Imaging Methods Pract. 2023 Oct 25;1(2):qyad030. doi: 10.1093/ehjimp/qyad030. eCollection 2023 Sep.
The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD). This study aimed to provide an assessment of right heart function using conventional echocardiography and advanced strain imaging, in patients with hypoxic pneumonia during the COVID-19 pandemic.
This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 pneumonia. Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Descriptive and comparative statistics were used to analyse data. Spearman Rank Order Correlations were used to determine the correlation between right ventricular (RV) parameters and clinical parameters. Univariate and multivariate logistic regression analyses were performed to characterize the predictors of in-hospital mortality. We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 pneumonia. COVID-19 patients were significantly older with a higher frequency of hypertension and diabetes and a trend towards a lower severity of illness score. Mean RVFWS yielded the highest estimates for the prevalence of RVD (81%), with no difference between the two pneumonia groups. Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular systolic excursion velocity (RVS') were not significantly different between COVID-19 (TAPSE 17.2 and RVS' 12), and non-COVID-19 pneumonia (TAPSE 17.8 and RVS' 12.1) with values of 0.29 and 0.86, respectively. Non-COVID-19 pneumonia patients with moderate to severe hypoxaemia (PF < 150) were at greater risk of an elevated RV Systolic Pressure >30 mmHg respiratory rate = 3.25 (CI 1.35-7.82) on admission. Troponin levels discriminated between COVID-19 survivors (6 ng/L) and non-survivors (13 ng/L), = 0.04. The mortality rate for COVID-19 was high (27%) compared to non-COVID-19 pneumonia (12%).
Patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID-19 pneumonia. Despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, and we propose that RVFWS serves as an important marker of the subclinical disease of RV.
新型冠状病毒肺炎（COVID-19）可通过多种机制影响右心室，进而导致右心室功能障碍（RVD）。本研究旨在利用传统超声心动图和先进的应变成像技术，对COVID-19大流行期间的缺氧性肺炎患者的右心功能进行评估。
本研究为一项观察性、前瞻性、单中心研究，纳入患有缺氧性肺炎的成人，分为两组：COVID-19肺炎组；和非COVID-19肺炎组。根据预先指定的方案进行床旁超声心动图检查，并按照标准指南进行所有右心测量。使用飞利浦®QLAB 11.0斑点追踪软件测量右心室游离壁应变（RVFWS）。采用描述性和比较性统计分析数据。使用Spearman等级相关分析来确定右心室（RV）参数与临床参数之间的相关性。进行单因素和多因素逻辑回归分析以确定院内死亡的预测因素。我们纳入了48例COVID-19肺炎患者和24例非COVID-19肺炎患者。COVID-19患者年龄显著更大，高血压和糖尿病的发生率更高，且疾病严重程度评分有降低趋势。平均RVFWS对RVD患病率的估计最高（81%），两组肺炎患者之间无差异。COVID-19组（三尖瓣环平面收缩期位移（TAPSE）为17.2，右心室收缩期位移速度（RVS'）为12）和非COVID-19肺炎组（TAPSE为17.8，RVS'为12.1）的TAPSE和RVS'中位数无显著差异，P值分别为0.29和0.86。入院时，中度至重度低氧血症（PF<150）的非COVID-19肺炎患者发生右心室收缩压>30 mmHg升高的风险更高，呼吸频率=3.25（CI 1.35 - 7.82）。肌钙蛋白水平可区分COVID-19幸存者（6 ng/L）和非幸存者（13 ng/L），P = 0.04。与非COVID-19肺炎（12%）相比，COVID-19的死亡率较高（27%）。
与非COVID-19肺炎患者相比，COVID-19肺炎患者入院时RVD的患病率相似。尽管右心室收缩功能的传统参数保持正常，但两组患者的RVFWS均降低，我们认为RVFWS是右心室亚临床疾病的重要标志物。
