Key result
Reduced LVEF (≤50%) and reduced TAPSE (≤17 mm) were significantly associated with higher in-hospital mortality in COVID-19 patients (HR 4.06 and HR 5.08, respectively).
Why the study?
COVID-19 can be complicated by ARDS and cardiovascular complications, but the clinical conditions and echocardiographic parameters associated with in-hospital mortality were not well defined.
Are reduced LVEF, reduced TAPSE, and ARDS associated with increased in-hospital mortality in patients hospitalized with COVID-19?
Observational (n=226)
Yes
Are reduced LVEF, reduced TAPSE, and ARDS associated with increased in-hospital mortality in patients hospitalized with COVID-19?
Hazard Ratio: 4.06 (95% CI 2.5–6.59)
p-value: p=<.001
Reduced LVEF (≤50%) and TAPSE (≤17 mm) on transthoracic echocardiography are strongly associated with in-hospital mortality in patients with COVID-19, suggesting TTE is a useful tool for risk stratification.
Supports TTE for risk stratification in COVID-19 inpatients; leaves open whether findings guide therapy or improve survival.
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19. METHODS: This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses. RESULTS: Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < .001), tricuspid annular plane systolic excursion (TAPSE, P < .001) and ARDS (P < .001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95-14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15-8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50-6.59). CONCLUSIONS: TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.
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Silverio et al. (2021) conducted an observational in COVID-19 (n=226). Reduced LVEF (≤50%) vs. LVEF >50% was evaluated on In-hospital mortality (HR 4.06, 95% CI 2.50-6.59, p=<.001). Reduced LVEF (≤50%) and reduced TAPSE (≤17 mm) were significantly associated with higher in-hospital mortality in COVID-19 patients (HR 4.06 and HR 5.08, respectively).
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