Echocardiographic 60-day mortality markers in patients hospitalized in intensive care for COVID-19

• Published in: Heart & lung Vol. 52; pp. 123 - 129
• Main Authors: Díaz, John Jaime Sprockel, Rincon, Juan Manuel, López, Manuela Alejandra Rondón, Zuleta, Marisol Bejarano, Castellanos, Nathaly, Saavedra, Zulima Santofimio, Rodríguez, Hellen Cárdenas, Barrera, Diego Felipe Hernandez, Parra, Jhon Edison, Fernández, Juan José Diaztagle
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022
• Subjects: acute cor pulmonale; COVID-19; Critical Care; echocardiogram; Echocardiography; Female; Humans; mortality; prognostic; Prospective Studies; Ventricular Dysfunction, Right - complications; CI; LVEF; HR; TAPSE; PASP; APACHE II; AUC; COVID-19; prognostic; SOFA; echocardiogram; mortality; BUN; acute cor pulmonale; ARDS; SGPT; SGOT
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2021.12.007

•There are few reports about the characteristics of echocardiographic images in the patients who have the severe forms of COVID-19.•In a cohort of 153 patients with an echocardiogram in the ICU, right diastolic dysfunction was documented in 26.8%, pulmonary hypertension in 71% and 48.4% had some left ventricular diastolic dysfunction. Only 7.8% showed alterations in myocardial contractility.•Acute cor pulmonale had low prevalence; it was found in only five cases (3.3%), compared with 22% reported in ARDS patients on protective ventilation.•The results of the multivariate analysis showed that acute cor pulmonale (HR= 4.05, CI 95% 1.09 - 15.02, p 0.037), right ventricular dilatation (HR= 3.33, CI 95% 1.29 - 8.61, p 0.013), and LVEF (HR= 0.94, CI 95% 0.89 - 0.99, p 0.020) were variables that had statistically significant association with mortality. Coronavirus disease COVID-19 produces a predominantly pulmonary affection, being cardiac involvement an important component of the multiorganic dysfunction. At the moment there are few reports about the behavior of echocardiographic images in the patients who have the severe forms of the disease. Identify the echocardiographic prognostic markers for death within 60 days in patients hospitalized in intensive care. A single-center prospective cohort was made with patients hospitalized in intensive care for COVID-19 confirmed via polymerase chain reaction who got an echocardiogram between May and October 2020. A Cox multivariate model was plotted reporting the HR and confidence intervals with their respective p values for clinical and echocardiographic variables. Out of the 326 patients included, 153 patients got an echocardiogram performed on average 6.8 days after admission. The average age was 60.7, 47 patients (30.7%) were females and 67 (44.7%) registered positive troponin. 91 patients (59.5%) died. The univariate analysis identified TAPSE, LVEF, pulmonary artery systolic pressure, acute cor pulmonale, right ventricle diastolic dysfunction, and right ventricular dilatation as variables associated with mortality. The multivariate model identified that the acute cor pulmonale with HR= 4.05 (CI 95% 1.09 - 15.02, p 0.037), the right ventricular dilatation with HR= 3.33 (CI 95% 1.29 - 8.61, p 0.013), and LVEF with HR= 0.94 (CI 95% 0.89 - 0.99, p 0.020) were associated with mortality within 60 days. In patients hospitalized in the intensive care unit for COVID-19, the LVEF, acute cor pulmonale and right ventricular dilatation are prognostic echocardiographic markers associated with death within 60 days.