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Master of Public Health

Early Serial Echocardiographic and Ultrasonographic Findings in Critically Ill Patients With COVID-19

AUTHORS

Lanspa MJ , Dugar SP , Prigmore HL , Boyd JS , Rupp JD , Lindsell CJ , Rice TW , Qadir N , Lim GW , Shiloh AL , Dieiev V , Gong MN , Fox SW , Hirshberg EL , Khan A , Kornfield J , Schoeneck JH , Macklin N , Files DC , Gibbs KW , Prekker ME , Parsons-Moss D , Bown M , Olsen TD , Knox DB , Cirulis MM , Mehkri O , Duggal A , Tenforde MW , Patel MM , Self WH , Brown SM , , . CHEST critical care. 2023 3 22; 1(1). 100002

ABSTRACT

BACKGROUND: Cardiac function of critically ill patients with COVID-19 generally has been reported from clinically obtained data. Echocardiographic deformation imaging can identify ventricular dysfunction missed by traditional echocardiographic assessment.

RESEARCH QUESTION: What is the prevalence of ventricular dysfunction and what are its implications for the natural history of critical COVID-19?

STUDY DESIGN AND METHODS: This is a multicenter prospective cohort of critically ill patients with COVID-19. We performed serial echocardiography and lower extremity vascular ultrasound on hospitalization days 1, 3, and 8. We defined left ventricular (LV) dysfunction as the absolute value of longitudinal strain of < 17% or left ventricle ejection fraction (LVEF) of < 50%. Primary clinical outcome was inpatient survival.

RESULTS: We enrolled 110 patients. Thirty-nine (35.5%) died before hospital discharge. LV dysfunction was present at admission in 38 patients (34.5%) and in 21 patients (36.2%) on day 8 ( = .59). Median baseline LVEF was 62% (interquartile range [IQR], 52%-69%), whereas median absolute value of baseline LV strain was 16% (IQR, 14%-19%). Survivors and nonsurvivors did not differ statistically significantly with respect to day 1 LV strain (17.9% vs 14.4%;  = .12) or day 1 LVEF (60.5% vs 65%;  = .06). Nonsurvivors showed worse day 1 right ventricle (RV) strain than survivors (16.3% vs 21.2%;  = .04).

INTERPRETATION: Among patients with critical COVID-19, LV and RV dysfunction is common, frequently identified only through deformation imaging, and early (day 1) RV dysfunction may be associated with clinical outcome.

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