Prognostic Value of Right Ventricular Longitudinal Strain in Patients With COVID-19
Prognostic Value of Right Ventricular Longitudinal Strain in Patients With COVID-19
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DOI：
10.1016/j.jcmg.2020.04.014
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发表时间：
2020-11-01
影响因子：
14
通讯作者：
Xie, Mingxing
中科院分区：
文献类型：
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作者：
Li, Yuman;Li, He;Xie, Mingxing
目的 本研究的目的是调查右心室纵向应变 (RVLS) 是否可以独立预测 2019 年冠状病毒病 (COVID-19) 患者的较高死亡率。 背景 从二维斑点跟踪超声心动图获得的 RVLS 最近已被证明是评估右心室 (RV) 功能的更准确和更灵敏的工具。 RVLS 对 COVID-19 患者的预后价值仍不清楚。 方法 我们的研究纳入了 120 名连续接受超声心动图检查的 COVID-19 患者。获得常规右心室功能参数，包括右心室面积变化分数、三尖瓣环平面收缩期偏移和三尖瓣组织多普勒环速度。 RVLS 使用二维斑点追踪超声心动图确定。 RV 功能按 RVLS 的三分位进行分类。结果与 RVLS 最高三分位的患者相比，处于最低三分位的患者更有可能出现较高的心率。 D-二聚体和 C-反应蛋白水平升高；更多的高流量吸氧和有创机械通气治疗；急性心脏损伤、急性呼吸窘迫综合征和深静脉血栓的发生率较高；和更高的死亡率。中位随访期 51 天后，18 名患者死亡。与幸存者相比，非幸存者表现出右心室增大、右心室功能减弱和肺动脉收缩压升高。男性、急性呼吸窘迫综合征、RVLS、RV面积分数变化和三尖瓣环平面收缩期偏移是较高死亡率风险的显着单变量预测因素（所有因素p < 0.05）。使用 RVLS 的 Cox 模型（风险比：1.33；95% 置信区间 [CI]：1.15 至 1.53；p < 0.001；Akaike 信息标准 = 129；C 指数 = 0.89）比使用 RV 分数面积变化（Akaike 信息标准 = 142，Cindex = 0.84）和三尖瓣环平面的模型更准确地预测更高的死亡率收缩期偏移（Akaike 信息标准 = 144，C 指数 = 0.83）。 RVLS 预测结果的最佳截断值类似于 23%（AUC：0.87；p < 0.001；敏感性，94.4%；特异性，64.7%）。 结论 RVLS 是 COVID-19 患者死亡率较高的有力预测因子。这些结果支持应用 RVLS 来识别感染 COVID-19 的高风险患者。 (C) 2020 年，美国心脏病学会基金会。
OBJECTIVES The aim of this study was to investigate whether right ventricular longitudinal strain (RVLS) was independently predictive of higher mortality in patients with coronavirus disease-2019 (COVID-19).BACKGROUND RVLS obtained from 2-dimensional speckle-tracking echocardiography has been recently demonstrated to be a more accurate and sensitive tool to estimate right ventricular (RV) function. The prognostic value of RVLS in patients with COVID-19 remains unknown.METHODS One hundred twenty consecutive patients with COVID-19 who underwent echocardiographic examinations were enrolled in our study. Conventional RV functional parameters, including RV fractional area change, tricuspid annular plane systolic excursion, and tricuspid tissue Doppler annular velocity, were obtained. RVLS was determined using 2-dimensional speckle-tracking echocardiography. RV function was categorized in tertiles of RVLS.RESULTS Compared with patients in the highest RVLS tertile, those in the lowest tertile were more likely to have higher heart rate; elevated levels of D-dimer and C-reactive protein; more high-flow oxygen and invasive mechanical ventilation therapy; higher incidence of acute heart injury, acute respiratory distress syndrome, and deep vein thrombosis; and higher mortality. After a median follow-up period of 51 days, 18 patients died. Compared with survivors, nonsurvivors displayed enlarged right heart chambers, diminished RV function, and elevated pulmonary artery systolic pressure. Male sex, acute respiratory distress syndrome, RVLS, RV fractional area change, and tricuspid annular plane systolic excursion were significant univariate predictors of higher risk for mortality (p < 0.05 for all). A Cox model using RVLS (hazard ratio: 1.33; 95% confidence interval [CI]: 1.15 to 1.53; p < 0.001; Akaike information criterion = 129; C-index = 0.89) was found to predict higher mortality more accurately than a model with RV fractional area change (Akaike information criterion = 142, Cindex = 0.84) and tricuspid annular plane systolic excursion (Akaike information criterion = 144, C-index = 0.83). The best cutoff value of RVLS for prediction of outcome was similar to 23% (AUC: 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. These results support the application of RVLS to identify higher risk patients with COVID-19. (C) 2020 by the American College of Cardiology Foundation.