McErlane, J., McCall, P. , Willder, J., Berry, C. and Shelley, B. (2022) Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19. Annals of Intensive Care, 12(1), 104. (doi: 10.1186/s13613-022-01077-7) (PMID:36370220) (PMCID:PMC9652604)
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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.
| Item Type: | Articles |
|---|---|
| Additional Information: | This work was supported by Medical Research Scotland (grant number CVG-1730-2020). BS is supported by the National Institute of Academic Anaesthesia/Royal College of Anaesthetists British Oxygen Company Chair of Anaesthesia Research Grant. CB receives research funding from the British Heart Foundation grant (RE/18/6/34217), Chief Scientist Office, EPSRC (EP/R511705/1, EP/S030875/1), European Union (754946-2), Medical Research Council (MR/S018905/1) and UKRI (MC/PC/20014). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Berry, Professor Colin and McCall, Dr Philip and Shelley, Dr Benjamin and McErlane, Dr James |
| Authors: | McErlane, J., McCall, P., Willder, J., Berry, C., and Shelley, B. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Annals of Intensive Care |
| Publisher: | SpringerOpen |
| ISSN: | 2110-5820 |
| ISSN (Online): | 2110-5820 |
| Published Online: | 12 November 2022 |
| Copyright Holders: | Copyright © The Author(s) 2022 |
| First Published: | First published in Annals of Intensive Care 21(1):104 |
| Publisher Policy: | Reproduced under a Creative Commons license |
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