Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

James McErlane, Philip McCall, Jennifer Willder, Colin Berry, Ben Shelley, COVID-RV investigators, 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, James McErlane, Philip McCall, Jennifer Willder, Colin Berry, Ben Shelley, COVID-RV investigators, 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.

Keywords: Coronavirus disease 2019; Mechanical ventilation; Right ventricle; Speckle tracking echocardiography.

Conflict of interest statement

Colin Berry is employed by the University of Glasgow which holds consultancy and research agreements for his work with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Causeway Therapeutics, Coroventis, Genentech, GSK, HeartFlow, Menarini, Neovasc, Siemens Healthcare, and Valo Health. No other competing interests declared.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Survival Analysis. A Histogram displaying the distribution of Right Ventricular Free-Wall Longitudinal Strain (RVFWLS) in survivors and non-survivors. Percentage of patients in each 2% grouping of RVFWLS are shown by the histogram bars. Histogram bars from survivors and non-survivors are stacked upon each other. B Kaplan–Meier and log rank analysis of patients with normal RVFWLS (≤ −20%) (blue) compared to abnormal RVFWLS (> −20%) (red). Kaplan–Meier plot displays cumulative survival in the groups up to 30 days after ICU admission

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