Key result
Right ventricular dysfunction on transthoracic echocardiography was significantly associated with increased mortality in hospitalized patients with severe-critical COVID-19 (OR 3.53).
Why the study?
Cardiac involvement in COVID-19 is associated with poor outcomes, prompting investigation into the prognostic value of transthoracic echocardiography findings in hospitalized adult patients.
Does transthoracic echocardiography (TTE) provide prognostic value for disease severity and mortality in hospitalized adult patients with COVID-19?
Observational (n=488)
No
Does transthoracic echocardiography (TTE) provide prognostic value for disease severity and mortality in hospitalized adult patients with COVID-19?
Odds Ratio: 3.53 (95% CI 1.12–11.19)
p-value: p=<0.05
Transthoracic echocardiography findings, specifically right ventricular dysfunction and wall motion abnormalities, are associated with increased mortality in hospitalized COVID-19 patients.
TTE parameters may aid risk stratification in hospitalized COVID-19; leaves open whether findings should guide management or trials.
Background Cardiac involvement in coronavirus disease 2019 (COVID-19) is associated with poor outcomes. Transthoracic echocardiography (TTE) can be used to assess cardiac structure and function non-invasively, and has been shown to influence management in COVID-19. Objectives We aim to investigate the prognostic value of TTE findings in hospitalized adults with confirmed COVID-19. Methods All consecutive hospitalized adult patients with confirmed COVID-19 who underwent TTE assessment between 3rd April 2020 – 6th April 2021 were included. Comprehensive clinical data including TTE findings were collected from electronic medical records. Patients with mild-moderate and severe-critical COVID-19 were compared. Within the severe-critical group, patients who survived hospitalization and died were compared. Further analyses were conducted after matching for age >60 years, obesity, and diabetes. Results A total of 488 COVID-19 patients were included in this study; 202 with mild-moderate and 286 severe-critical disease. All mild-moderate patients and 152 severe-critical patients survived hospitalization. In the matched cohorts, TTE findings associated with severe-critical COVID-19 included left ventricular (LV) hypertrophy (OR: 1.91; CI: 1.21 – 3.02), LV diastolic dysfunction (OR: 1.55; CI: 1.00 – 2.38), right ventricular (RV) dysfunction (OR: 3.86; CI: 1.06 – 14.08), wall motion abnormalities (WMAs) (OR: 2.76; CI: 1.28 – 5.96), and any TTE abnormalities (OR: 2.99; CI: 1.73 – 5.17). TTE findings associated with mortality included RV dysfunction (OR: 3.53; CI: 1.12 – 11.19) and WMAs (OR: 2.63; CI: 1.26 – 5.49). Conclusion TTE is a non-invasive modality that can potentially be used for risk-stratification of hospitalized COVID-19 patients. These findings must be confirmed in larger prospective studies.
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Muliawan et al. (2022) conducted an observational in COVID-19 (n=488). Right ventricular dysfunction on transthoracic echocardiography vs. Absence of right ventricular dysfunction was evaluated on Mortality (OR 3.53, 95% CI 1.12-11.19, p=<0.05). Right ventricular dysfunction on transthoracic echocardiography was significantly associated with increased mortality in hospitalized patients with severe-critical COVID-19 (OR 3.53).
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