Right ventricular longitudinal strain (RVLS) may help predict mortality risk in patients with COVID-19, according to a study from Wuhan, China, published April 28 in JACC: Cardiovascular Imaging.

Yuman Li, MD, PhD, et al., performed two-dimensional speckle-tracking echocardiography (2D-STE) to determine whether RVLS was independently predictive of mortality in patients with COVID-19. The researchers obtained conventional right ventricular (RV) function, including RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and tricuspid tissue Doppler annular velocities. RV function was classified by tertiles of RVLS.

The final study cohort consisted of 120 patients with COVID-19 and 37 healthy volunteers without cardiopulmonary disease who served as a control group. The mean age of patients was 61 years, and 48% were men. Among patients with COVID-19, six also had chronic obstructive pulmonary disease. None of the patients had a history or new diagnosis of pulmonary embolism. Patients in the lowest RVLS tertile were more likely to have a higher heart rate, D-dimer and C-reactive protein, high-flow oxygen and invasive mechanical ventilation therapy, higher incidence of acute myocardial injury, acute respiratory distress syndrome, and deep vein thrombosis.

After a median follow up of 51 days, 18 patients died. There were no significant differences in left heart structure and left ventricular (LV) systolic and diastolic function between survivors and nonsurvivors. However, nonsurvivors were more likely to have an enlarged right-heart chamber and pulmonary artery; lower RVLS, RVFAC and TAPSE; and elevated pulmonary artery systolic pressure. Mortality was highest among patients with RVLS ≤20.5%, followed by RVLS in the range between 20.6% and 25.4%, and lowest among patients with RVLS ≥25.5% (p<0.001). In addition, mortality increased with lower RVFAC and TAPSE.

According to the researchers, RVLS predicted a higher mortality risk in COVID-19 patients, independent of other echocardiographic parameters. Evaluation of RV function and RVLS should be implemented for risk stratification in COVID-19 patients, they conclude.

Clinical Topics: COVID-19 Hub

Keywords: Respiratory Distress Syndrome, Coronavirus, Coronavirus Infections, COVID-19, severe acute respiratory syndrome coronavirus 2

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