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. 2021 Jun:6:100018.
doi: 10.1016/j.ahjo.2021.100018. Epub 2021 Jun 1.

Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19

Jakob Park  1 , Yekaterina Kim  2 , Jason Pereira  2 , Kerrilynn C Hennessey  2 , Kamil F Faridi  2 , Robert L McNamara  2 , Eric J Velazquez  2 , David J Hur  2 , Lissa Sugeng  2 , Vratika Agarwal  2
Affiliations

Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19

Jakob Park et al. Am Heart J Plus. 2021 Jun.

Abstract

Background: Coronavirus disease 2019 (COVID-19) can cause cardiac injury resulting in abnormal right or left ventricular function (RV/LV) with worse outcomes. We hypothesized that two-dimensional (2D) speckle-tracking assessment of LV global longitudinal strain (GLS) and RV free wall strain (FWS) by transthoracic echocardiography can assist as markers for subclinical cardiac injury predicting increased mortality.

Methods: We performed 2D strain analysis via proprietary software in 48 patients hospitalized with COVID-19. Clinical information, demographics, comorbidities, and lab values were collected via retrospective chart review. The primary outcome was in-hospital mortality based on an optimized abnormal LV GLS value via ROC analysis and RV FWS.

Results: The optimal LV GLS cutoff to predict death was -13.8%, with a sensitivity of 85% (95% CI 55-98%) and specificity of 54% (95% CI 36-71%). Abnormal LV GLS >-13.8% was associated with a higher risk of death [unadjusted hazard ratio 5.15 (95% CI 1.13-23.45), p = 0.034], which persisted after adjustment for clinical variables. Among patients with LV ejection fraction (LVEF) >50%, those with LV GLS > -13.8% had higher mortality compared to those with LV GLS <-13.8% (41% vs. 10%, p = 0.030). RV FWS value was higher in patients with LV GLS >-13.8% (-13.7 ± 5.9 vs. -19.6 ± 6.7, p = 0.003), but not associated with decreased survival.

Conclusion: Abnormal LV strain with a cutoff of >-13.8% in patients with COVID-19 is associated with significantly higher risk of death. Despite normal LVEF, abnormal LV GLS predicted worse outcomes in patients hospitalized with COVID-19. There was no mortality difference based on RV strain.

Keywords: 2D, Two-dimensional; ARDS, acute respiratory distress syndrome; COVID-19; COVID-19, Coronavirus Disease 2019; EF, ejection fraction; FAC, fractional area change; FWS, free wall strain; GLS, global longitudinal strain; HFrEF, heart failure reduced ejection fraction; Hs-TNT, high sensitivity troponin T; ICC, intra-class correlation coefficient; LV, left ventricle; Left ventricular strain; NT-proBNP, NT-pro-brain natriuretic peptide; RV, right ventricle; Speckle-tracking echocardiography; TTE, transthoracic echocardiography.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Echocardiographic measurements of LV GLS. Offline speckle-tracking analysis of the left ventricle using the analysis software 2D STRAIN (2D Cardiac Performance Analysis v1.2, Tomtec Imaging Systems GmbH, Unterschleissheim, Germany) in an apical 4-chamber view. The myocardial contours are automatically tracked and manually adjusted if needed (left side). An 18-segment bull's eye plot offers information of the strain noted in each segment of the left ventricle (right side). Blue segments (not seen here) reach their longitudinal strain peak before the end systolic period, while red segments reach minimal strain after end-systole. Full resolution images with additional views required for measurement (including right ventricle) are found in the Supplemental Figure. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Survival curves by LV EF and LV GLS status.
See this image and copyright information in PMC

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