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Prognostic Value of Right Ventricular Longitudinal Strain in Patients with COVID-19

Li Y, Li H, Zhu S, Xie Y, Wang B, He L, Zhang D, Zhang Y, Yuan H, Wu C, Sun W, Zhang Y, Li M, Cui L, Cai Y, Wang J, Yang Y, Lv Q, Zhang L, Xie M, Prognostic Value of Right Ventricular Longitudinal Strain in Patients with COVID-19, JACC: Cardiovascular Imaging (2020), doi: https://doi.org/10.1016/j.jcmg.2020.04.014.

Study Question: The right ventricular (RV) is susceptible to acute changes secondary to volume overload. Such changes appear to be a potential predictor of COVID – 19 mortality. Because standard echocardiographic parameters are not optimal to assess such changes, the focus of this report Is whether echocardiographic derived right ventricular longitudinal strain (RVLS) is a useful predictor to identify right ventricular function changes as a risk for adverse COVID 19 outcomes.

Key Points:

  • Consecutive echocardiograms from 120 consecutive patients with COVID – 19 were analyzed.
  • RVLS was categorized by tertiles of RV function compared to standard RV echocardiographic parameters.
  • Patients in the highest tertile of RVLS were more likely to multiple risk factors for adverse outcome in conjunction with RV failure including higher D-dimer, invasive mechanical ventilation, greater acute heart injury, acute respiratory distress syndrome (ARDS), deep venous thrombosis and mortality.
  • Of 18 patients who died, non-survivors demonstrated greater RV enlargement, RV dysfunction and pulmonary artery elevations of systolic pressure.
  • RVLS was determined to be a useful predictor of RV dysfunction and worse COVID-19 survival.
  • The challenge is to better utilize early recognition of RV dysfunction as a predictor of adverse outcome and intervene early with novel strategies of RV support to hopefully change the course of this patient population.