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. 2020 Dec;7(6):4189-4197.
doi: 10.1002/ehf2.13044. Epub 2020 Oct 22.

Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study

Mats Christian Højbjerg Lassen  1 , Kristoffer Grundtvig Skaarup  1 , Jannie Nørgaard Lind  1 , Alia Saed Alhakak  1 , Morten Sengeløv  1 , Anne Bjerg Nielsen  1 , Caroline Espersen  1 , Kirstine Ravnkilde  1 , Raphael Hauser  1 , Liv Borum Schöps  1 , Eva Holt  1 , Niklas Dyrby Johansen  1 , Daniel Modin  1 , Kasper Djernaes  1 , Claus Graff  2 , Henning Bundgaard  3 , Christian Hassager  3 , Reza Jabbari  3 , Jørn Carlsen  3 , Anne-Mette Lebech  4 , Ole Kirk  4 , Uffe Bodtger  5 , Matias Greve Lindholm  6 , Gowsini Joseph  6 , Lothar Wiese  7 , Frank Vinholt Schiødt  8 , Ole Peter Kristiansen  9 , Emil Schwarz Walsted  10 , Olav Wendelboe Nielsen  9 , Birgitte Lindegaard Madsen  11 , Niels Tønder  12 , Thomas Benfield  13 , Klaus Nielsen Jeschke  14 , Charlotte Suppli Ulrik  14 , Filip Krag Knop  15 , Morten Lamberts  1 , Pradeesh Sivapalan  15 , Gunnar Gislason  1 , Jacob Louis Marott  16 , Rasmus Møgelvang  3   16 , Gorm Jensen  16 , Peter Schnohr  16 , Peter Søgaard  16 , Scott D Solomon  17 , Kasper Iversen  1 , Jens Ulrik Staehr Jensen  15 , Morten Schou  1 , Tor Biering-Sørensen  1   18
Affiliations

Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study

Mats Christian Højbjerg Lassen et al. ESC Heart Fail. 2020 Dec.

Abstract

Aims: The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death.

Methods and results: In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease.

Conclusions: RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.

Keywords: COVID-19; Echocardiography; Global longitudinal strain; Right ventricular strain; SARS-CoV-2.

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Conflict of interest statement

T.B.S. reports receiving research grants from Sanofi Pasteur, and GE Healthcare, is a Steering Committee member of the Amgen financed GALACTIC‐HF trial, on advisory boards for Sanofi Pasteur and Amgen, and speaker honorariums from Novartis and Sanofi Pasteur. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Study flow chart. Flow chart illustrating inclusion process for cases and controls for matched comparison and assessment of the prognostic value of echocardiography. BMI, body mass index.
Figure 2
Figure 2
Association between RV and LV echocardiography‐assessed function and COVID‐19‐related death. Displaying the unadjusted probability of COVID‐19‐related death (with 95% confidence intervals) for the population in relation to LVEF, GLS, TAPSE, and RVLS. GLS, global longitudinal strain, LVEF, left ventricular ejection fraction; RVLS, right ventricular longitudinal strain; TAPSE, tricuspid annular plane systolic excursion.
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