Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19
James McErlane, Philip McCall, Jennifer M. Willder, Colin Berry, Ben Shelley, A. Reece, C. Kitchen, M. Gillies, V. Dabek, V. Irvine, J. MacBrayne, K. Sim, T. Scott, E. Trumper, F. Savage, A. Allan, J. Falconer, A. Coutts, A. McDonald, J. Rutherford, D. Christie, C. Jardine, A. Puxty, M. Hughes, S. Cathcart, M. Sim, B. Docking, M. Thornton, B. Greatorex, J. Rae, C. Barr, C. Bradley, F. Barrett, R. Campbell, N. Clarke, M. Mascarenhas, J. Matheson, D. McDonald, M. O Hara, L. O keeffe, L. Gemmell, R. Price, M. McHendry, D. McLaughlan, C. Herman, H. Elliot, S. Meehan, J. Allan, D. Finn, G. Brannan, S. Wood, T. Watson, K. Ross, N. Tatarkowska, R. Boyle, E. Lee, D. Strachan, A. Morrison, P. Lucie, C. Lochrin, S. Clements, D. Vigni, B. Stanley, C.M. Messow
Abstract
BACKGROUND: Right ventricular (RV) dysfunction has been commonly reported in patients with Coronavirus disease 2019 (COVID-19), and is associated with mortality in mixed cohorts of patients requiring and not requiring invasive mechanical ventilation (IMV). Using RV-speckle tracking echocardiography (STE) strain analysis, we aimed to identify the prevalence of RV dysfunction (diagnosed by abnormal RV-STE) in patients with COVID-19 that are exclusively undergoing IMV, and assess association between RV dysfunction and 30 day mortality. We performed a prospective multicentre study across 10 ICUs in Scotland from 2/9/20 to 22/3/21. One-hundred-and-four echocardiography scans were obtained from adult patients at a single timepoint between 48 h after intubation, and day 14 of intensive care unit admission. We analysed RV-STE using RV free-wall longitudinal strain (RVFWLS), with an abnormal cutoff of > -20%. We performed survival analysis using Kaplan-Meier, log rank, and multivariate cox-regression (prespecified covariates were age, gender, ethnicity, severity of illness, and time since intubation). RESULTS: Ninety-four/one-hundred-and-four (90.4%) scans had images adequate for RVFWLS. Mean RVFWLS was -23.0% (5.2), 27/94 (28.7%) of patients had abnormal RVFWLS. Univariate analysis with Kaplan-Meier plot and log-rank demonstrated that patients with abnormal RVFWLS have a significant association with 30-day mortality (p = 0.047). Multivariate cox-regression demonstrated that abnormal RVFWLS is independently associated with 30-day mortality (Hazard-Ratio 2.22 [1.14-4.39], p = 0.020). CONCLUSIONS: Abnormal RVFWLS (> -20%) is independently associated with 30-day mortality in patients with COVID-19 undergoing IMV. Strategies to prevent RV dysfunction, and treatment when identified by RVFWLS, may be of therapeutic benefit to these patients. TRIAL REGISTRATION: Retrospectively registered 21st Feb 2021. CLINICALTRIALS: gov Identifier: NCT04764032.