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

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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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).
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
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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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
309324Optimisation of prediction models for red blood cell demandAlice MillerEngineering and Physical Sciences Research Council (EPSRC)EP/R511705/1Computing Science
303232EPSRC Centre for Multiscale soft tissue mechanics with MIT and POLIMI (SofTMech-MP)Xiaoyu LuoEngineering and Physical Sciences Research Council (EPSRC)EP/S030875/1M&S - Mathematics
303684A randomized, double-blind, placebo-controlled Phase 2A cross-over trial of oral zibotentan in patients with angina due to small vessel disease: a proof-of-concept, developmental trial for safety, efficacy and biomarkers developmentColin BerryMedical Research Council (MRC)MR/S018905/1CAMS - Cardiovascular Science
311395Right Ventricular Dysfunction in Ventilated Patients with COVID-19 (COVID-RV)Benjamin ShelleyMedical Research Scotland (MEDRESSC)CVG-1730-2020HW - Robertson Centre