Abstract 15561: Incremental Prognostic Value of Biventricular Longitudinal Strain and Hs-tni in Covid-19 Patients

Abstract

Background: Myocardial strain derived from two-dimensional speckle-tracking echocardiography (2D-STE) has been shown to be more sensitive to detect early ventricular dysfunction than conventional echocardiography. However, the study about the prognostic value of biventricular longitudinal strain in coronavirus disease 2019 (COVID-19) is still scarce. Aims: We aimed to evaluate the prognostic value of biventricular longitudinal strain and its combination with high-sensitivity troponin I (hs-TNI) in COVID-19 patients. Methods: We enrolled a total of 160 COVID-19 patients who underwent both echocardiogram and hs-TNI testing. The cardiac structure, function and myocardial strain were compared between patients with and without elevated hs-TNI levels. Left ventricular longitudinal strain (LV LS) and right ventricular free wall longitudinal strain (RVFWLS) were determined by 2D-STE. Results: Compared with patients with normal hs-TNI levels, patients with elevated hs-TNI levels had diminished LV diastolic function, larger right-heart chamber, higher proportion of pulmonary hypertension, lower LV LS and RVFWLS. During a median follow-up of 60 days, 23 patients died. The multivariant analysis revealed LV LS and RVFWLS [Odd ratio (confidence interval): 1.533 (1.131-2.079); P =0.006; 1.267 (1.101-1.794), P =0.021, respectively] both were the independent predictors of higher mortality. Further, receiver-operating characteristic analysis revealed that the accuracy for predicting death was greater for the combination of hs-TNI levels with LV LS than separate LV LS (AUC: 0.93 vs 0.77, P =0.001), and for the combination of hs-TNI levels with RVFWLS than RVFWLS alone (AUC: 0.92 vs 0.83, P =0.041). Conclusion: Our study highlights that the combination of ventricular longitudinal strain with hs-TNI can provide a higher accuracy for predicting mortality in COVID-19 patients, which may enhance risk stratification in COVID-19 patients.