Abstract
Background: RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in coronavirus disease 2019 (COVID-19) remains unknown. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients.Methods: A cohort of 128 COVID-19-confirmed patients who had undergone echocardiography were studied. Thirty-one healthy volunteers were also enrolled as controls. COVID-19 patients were divided into three subgroups (general, severe, and critical) according to COVID-19 severity-of-illness. Conventional RV structure and function parameters, RV free wall longitudinal strain (FWLS) and 3D-RVEF were acquired. RVFWLS was measured by two-dimensional speckle tracking echocardiography. RVEF was acquired by 3DE.Results: Compared with controls, 2D-RVFWLS and 3D-RVEF were both significantly decreased in COVID-19 patients (−27.2 ± 4.4% vs. −22.9 ± 4.8%, P < 0.001; 53.7 ± 4.5% vs. 48.5 ± 5.8%, P < 0.001). Critical patients were more likely to have a higher incidence of acute cardiac injury and acute respiratory distress syndrome (ARDS), and worse prognosis than general and severe patients. The critical patients exhibited larger right-heart chambers, worse RV fractional area change (RVFAC), 2D-RVFWLS, and 3D-RVEF and higher proportion of pulmonary hypertension than general and severe patients. Eighteen patients died during a median follow-up of 91 days. The multivariate Cox regression analysis revealed the acute cardiac injury, ARDS, RVFAC, RVFWLS, and 3D-RVEF were independent predictors of death. 3D-RVEF (chi-square to improve 18.3; P < 0.001), RVFAC (chi-square to improve 4.5; P = 0.034) and 2D-RVFWLS (chi-square to improve 5.1; P = 0.024) all provided additional prognostic value of higher mortality over clinical risk factors. Moreover, the incremental predictive value of 3D-RVEF was significantly (P < 0.05) higher than RVFAC and RVFWLS.Conclusion: 3D-RVEF was the most robust independent predictor of mortality in COVID-19 patients and provided a higher predictive value over conventional RV function parameters and RVFWLS, which may be helpful to identify COVID-19 patients at a higher risk of death.
Highlights
Cardiac injury was a prevalent complication and was associated with worse prognosis in COVID-19 patients, with an incidence ranging from 7.2 to 27.8% [1,2,3,4,5]
The intraobserver and interobserver intra-class correlation coefficients (ICC) for right ventricular free wall longitudinal strain (RVFWLS) were 0.95 and 0.90, 3D-RVEF were 0.95 and 0.91. This is the first study to comprehensively depict the conventional, 2D strain and Threedimensional echocardiography (3DE) characteristics of right ventricular (RV) in COVID-19 patients with different severity of illness and to explore the prognostic value of 3D-RVEF in COVID-19 patients by directly comparing its utility with that derived from conventional echocardiography and 2D-Speckle-tracking echocardiography (STE)
The increased cardiac stress due to respiratory failure and hypoxemia may contribute to cardiac injury and the RV may bear the brunt of its impact [3, 25]
Summary
Cardiac injury was a prevalent complication and was associated with worse prognosis in COVID-19 patients, with an incidence ranging from 7.2 to 27.8% [1,2,3,4,5]. Echocardiography is a convenient and widely available imaging tool for assessing cardiac function. Both left ventricular (LV) dysfunction and right ventricular (RV) dysfunction are noted in hospitalized COVID19 patients, the incidence of the latter is higher and the worse RV function is associated with clinical deterioration (i.e., hemodynamic instability, cardiac deterioration, and respiratory deterioration) [6,7,8]. Previous studies have proved that three–dimensional right ventricular ejection fraction (3D-RVEF) can provide valuable prognostic information in various cardiovascular diseases [10,11,12]. RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients
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