Biventricular Longitudinal Strain Predict Mortality in COVID-19 Patients

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

Background: Biventricular longitudinal strain has been recently demonstrated to be predictive of poor outcomes in various cardiovascular settings. Therefore, this study sought to investigate the prognostic implications of biventricular longitudinal strain in patients with coronavirus disease 2019 (COVID-19). Methods: We enrolled 132 consecutive patients with COVID-19. Left ventricular global longitudinal strain from the apical four-chamber views (LV GLS(4CH)) and right ventricular free wall longitudinal strain (RV FWLS) were obtained using two-dimensional speckle-tracking echocardiography. Results: Compared with patients without cardiac injury, those with cardiac injury had higher levels of coagulopathy and inflammatory biomarkers, higher incidence of complications, more mechanical ventilation therapy, and higher mortality. Patients with cardiac injury displayed decreased LV GLS(4CH) and RV FWLS, elevated pulmonary artery systolic pressure, and higher proportion of pericardial effusion. Higher biomarkers levels of inflammation and cardiac injury, and the presence of pericardial effusion were correlated with decreases in LV GLS(4CH) and RV FWLS. During hospitalization, 19 patients died. Compared with survivors, LV GLS(4CH) and RV FWLS were impaired in non-survivors. At a 3-month follow-up after discharge, significant improvements were observed in LV GLS(4CH) and RV FWLS. Multivariate Cox analysis revealed that LV GLS(4CH) [hazard ratio: 1.41; 95% confidence interval [CI]: 1.08 to 1.84; P = 0.011] and RV FWLS (HR: 1.29; 95% CI: 1.09–1.52; P = 0.003) were independent predictors of higher mortality in patients with COVID-19. Conclusions: LV GLS(4CH) and RV FWLS are independent and strong predictors of higher mortality in COVID-19 patients and can track improvement during the convalescent phase of their illness. Therefore, biventricular longitudinal strain may be crucial for risk stratification and serial follow-up in patients with COVID-19.