Prognostic Value of Right Ventricular Longitudinal Strain in Patients with COVID-19

Li, Yuman; Li, He; Zhu, Shuangshuang; Xie, Yuji; Wang, Bin; He, Lin; Zhang, Danqing; Zhang, Yongxing; Yuan, Hongliang; Wu, Chun; Sun, Wei; Zhang, Yanting; Li, Meng; Cui, Li; Cai, Yu; Wang, Jing; Yang, Yali; Lv, Qing; Zhang, Li; Xie, Mingxing

Abstract Objectives We aimed to investigate whether right ventricular longitudinal strain (RVLS) was independently predictive of higher mortality in coronavirus disease 2019 (COVID-19) patients. Background RVLS obtained from two-dimensional speckle-tracking echocardiography (2D-STE) has been recently demonstrated to be a more accurate and sensitive tool to estimate RV function. The prognostic value of RVLS in patients with COVID-19 remains unknown. Methods 120 consecutive patients with COVID-19 who underwent echocardiography examination were enrolled in our study. Conventional right ventricular (RV) function parameters, including RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and tricuspid tissue Doppler annular velocities (S’), were obtained. RVLS was determined by 2D-STE. RV function was categorized by tertiles of RVLS. Results Compared with patients in the highest RVLS tertile, those in the lowest tertile were more likely to have a higher heart rate, D-dimer and C-reactive protein, high-flow oxygen and invasive mechanical ventilation therapy, higher incidence of acute heart injury, acute respiratory distress syndrome (ARDS) and deep vein thrombosis, and higher mortality. After a median follow-up of 51 days, 18 patients died. Compared with survivors, non-survivors displayed enlarged right-heart chamber, diminished RV function, and elevated pulmonary artery systolic pressure. Male, ARDS, RVLS, RVFAC and TAPSE were significant univariate predictors of higher risk of mortality (P < 0.05 for all). The Cox model using RVLS (hazard ratio [HR]: 1.33, 95% confidence intervals [CI]: 1.15～1.53; P < 0.001; Akaike Information Criterion [AIC] =129; C-index = 0.89) was found to predict higher mortality more accurately than that with RVFAC (AIC =142; C-index = 0.84) and TAPSE (AIC = 144; C-index = 0.83). The best cutoff value of RVLS for prediction of outcome was −23% (area under the curve, 0.87; P < 0.001; sensitivity, 94.4%; specificity, 64.7%). Conclusions RVLS is a powerful predictor of higher mortality in patients with COVID-19. Our study supports the application of RVLS to identify higher risk COVID-19 patients.