Right Ventricular Longitudinal Strain May Predict Mortality in COVID-19 Paitents

A recent study published in JACC Cardiovascular Imaging suggests that right ventricular longitudinal strain (RVLS) may help predict mortality from COVID-19.

The researchers used RVLS speckle tracking echocardiography, which has been used as a more sensitive tool for assessing right ventricular function, to assess 120 consecutive patients with COVID-19. The team assessed traditional function parameters such as right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and tricuspid tissue Doppler annular velocities (S’). Right ventricular function was categorized according to tertiles of RVLS. Median follow-up was 51 days.

Patients in the highest tertiles of RVLS tended to have higher heart rates, higher D-dimer and C-reactive protein levels, higher high-flow oxygen, and higher levels of invasive mechanical ventilation therapy. They also had higher incidence of acute injury to the heart, higher levels of acute respiratory distress syndrome (ARDS), more deep-vein thrombosis, and higher mortality.

A total of 18 patients died during the course of the study. Non-survivors tended to have enlarged right heart chambers, diminished right ventricular function, and higher pulmonary-artery systolic pressure. Significant univariate predictors of mortality included male sex, ARDS, RVLS, RVFAC, and TAPSE (P<0.05 for all). When using a Cox model, RVLS predicted mortality at a higher rate than TAPSE and RVFAC.

“Right ventricular longitudinal strain is a powerful predictor of higher mortality in patients with COVID-19,” the researchers concluded. “Our study supports the application of RVLS to identify higher risk COVID-19 patients.”

An ACC news report on the study can be read here.

👉@JACCJournals: 🇨🇳Wuhan investigators analyze predictive value of RVLS in #COVID19🦠.
🔺⬇️ RVLS predicts ⬆️O2 and ventilation need, ARDS, DVT, and 💀, better AUC than TAPSE and RVFAC.
🔺Best cutoff value 23%
🔺Single center study, replicate in 🇪🇺+🇺🇸?https://t.co/oMhRWFdB3h pic.twitter.com/geatjWrK0I

— Enrique Garcia-Sayan, MD, FACC, FASE (@EGarciaSayan) May 4, 2020

Union Hospital team in #Wuhan, China demonstrate right ventricular longitudinal strain from 2D speckle-tracking is an independent determinant in #COVID19, suggesting greater predictive value over other #cvEcho parameters. Read more in a new #JACCIMG study. https://t.co/aappJf7PfB pic.twitter.com/AZlBge3g7K

— JACC Journals (@JACCJournals) April 30, 2020

RV strain is a powerful predictor of outcome in 120 COVID19 positive patients. #echofirst https://t.co/TART9tbJME@ShelbyKuttyMD @BarbaraCifra @strain_rate @AriCedars @FredWuMD @ErinMichos @MelisWasserman @GregTatum9 @AnastasiaSMihai @ZainabASamad @SudarRajagopal @fawazalenezi55 pic.twitter.com/if4cOqLaTA

— Daniel Forsha, MD, MHS (@daniel_forsha) May 6, 2020