Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

James Mcerlane,N Clarke,Philip Mccall,Jennifer Willder,A Coutts,A Mcdonald,Patricia Lucie ,R Boyle,N Tatarkowska,Bethany Stanley ,Martin Hughes ,C Barr,K Ross,Malcolm Sim ,S Cathcart,J Rutherford,C Jardine,A Reece,C Herman,Kheng Leng David Sim ,L O Keeffe,J Macbrayne,E Lee,J Falconer,E Trumper,J Rae,F Barrett,Mizuki Hara ,Colin Berry,D Finn,John N Allan ,Terry Scott ,C Lochrin,Rosemary J G Price ,C Kitchen,Ben Shelley,D M Mcdonald ,Lisa Gemmell ,M Thornton,F Savage,Alex Puxty ,Hazel Elliot ,M Mchendry,D Vigni,Michael Gillies ,D Christie,Dominic Strachan ,Suzanne Clements ,T Watson,G Brannan,Alanna C Morrison ,M Mascarenhas,Ross T Campbell ,V Dabek,B Docking,J Matheson,V Irvine,Ben Greatorex ,S Meehan,A Allan,D Mclaughlan,Stuart F Wood ,Conor Bradley ,Claudia Martina Messow

doi:10.1186/s13613-022-01077-7

Abstract

BackgroundRight ventricular (RV) dysfunction has been commonly reported in patients with Coronavirus disease 2019 (COVID-19), and is associated with mortality in mixed cohorts of patients requiring and not requiring invasive mechanical ventilation (IMV). Using RV-speckle tracking echocardiography (STE) strain analysis, we aimed to identify the prevalence of RV dysfunction (diagnosed by abnormal RV-STE) in patients with COVID-19 that are exclusively undergoing IMV, and assess association between RV dysfunction and 30 day mortality. We performed a prospective multicentre study across 10 ICUs in Scotland from 2/9/20 to 22/3/21. One-hundred-and-four echocardiography scans were obtained from adult patients at a single timepoint between 48 h after intubation, and day 14 of intensive care unit admission. We analysed RV-STE using RV free-wall longitudinal strain (RVFWLS), with an abnormal cutoff of > −20%. We performed survival analysis using Kaplan–Meier, log rank, and multivariate cox-regression (prespecified covariates were age, gender, ethnicity, severity of illness, and time since intubation).ResultsNinety-four/one-hundred-and-four (90.4%) scans had images adequate for RVFWLS. Mean RVFWLS was −23.0% (5.2), 27/94 (28.7%) of patients had abnormal RVFWLS. Univariate analysis with Kaplan–Meier plot and log-rank demonstrated that patients with abnormal RVFWLS have a significant association with 30-day mortality (p = 0.047). Multivariate cox-regression demonstrated that abnormal RVFWLS is independently associated with 30-day mortality (Hazard-Ratio 2.22 [1.14–4.39], p = 0.020).ConclusionsAbnormal RVFWLS (> −20%) is independently associated with 30-day mortality in patients with COVID-19 undergoing IMV. Strategies to prevent RV dysfunction, and treatment when identified by RVFWLS, may be of therapeutic benefit to these patients.Trial Registration: Retrospectively registered 21st Feb 2021. ClinicalTrials.gov Identifier: NCT04764032.

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