Early Serial Echocardiographic and Ultrasonographic Findings in Critically Ill Patients With COVID-19

• Published in: CHEST critical care 2023-06, Vol.1 (1), p.100002-100002, Article 100002
• Main Authors: Lanspa, Michael J., Dugar, Siddharth P., Prigmore, Heather L., Boyd, Jeremy S., Rupp, Jordan D., Lindsell, Chris J., Rice, Todd W., Qadir, Nida, Lim, George W., Shiloh, Ariel L., Dieiev, Vladyslav, Gong, Michelle N., Fox, Steven W., Hirshberg, Eliotte L., Khan, Akram, Kornfield, James, Schoeneck, Jacob H., Macklin, Nicholas, Files, D.Clark, Gibbs, Kevin W., Prekker, Matthew E., Parsons-Moss, Daniel, Bown, Mikaele, Olsen, Troy D., Knox, Daniel B., Cirulis, Meghan M., Mehkri, Omar, Duggal, Abhijit, Tenforde, Mark W., Patel, Manish M., Self, Wesley H., Brown, Samuel M., Calhoun, Nicole, Herrick, Judy, Hoffman, Eric, McKillop, Amanda, Murthy, Kempapura, Smith, Michael, Zayed, Martha, De Souza, Lesley, Kindle, Ryan, Kozikowski, Lori-Ann, Ouellette, Scott, Thornton-Thompson, Sherell, Bolstad, Michael, Ciottone, Robert, Coviello, Brianna, Devilla, Arnaldo, Grafals, Ana, Higgins, Conor, Ottanelli, Carlo, Redman, Kimberly, Scaffidi, Douglas, Weingart, Alexander, Lewis, Nathaniel, Olson, Samantha, Ashok, Kiran, Brennan, Connery, Mitchell, Megan, Poynter, Bryan, Stanley, Nicholas, Lohuis, Caitlin ten, Caspers, Sean, Erikson, Heidi, Hendrickson, Audrey, Kaus, Olivia, Maruggi, Ellen, Scharber, Tyler, Tordsen, Walker, Aston, Valerie, Bowers, Robert, Jorgensen, Jeffrey, King, Jennifer, Ali, Harith, Rothman, Richard E., Nair, Rahul, Chen, Jen-Ting, Karow, Sarah, Robart, Emily, Maldonado, Paulo Nunes, Khan, Maryiam, So, Preston, Schwartz, Elizabeth, So, Madison, Weigand, Michael, Luong, Andrea, Martinez, Jesus, Huynh, Bao, Ibrahim, Habiba, Villanueva-Vargas, Cynthia, Jung, Haeun, Villanueva-Vargas, Juliana, Quadri, Suha, Gordon, Alexandra Jun, Levitt, Joe, Perez, Cynthia, Visweswaran, Anita, Roque, Jonasel, Rivera, Adreanne
• Format: Article
• Language: English
• Subjects: Original Research
• ISSN: 2949-7884; 2949-7884
• DOI: 10.1016/j.chstcc.2023.100002

BackgroundCardiac function of critically ill patients with COVID-19 generally has been reported from clinically obtained data. Echocardiographic deformation imaging can identify ventricular dysfunction missed by traditional echocardiographic assessment.Research QuestionWhat is the prevalence of ventricular dysfunction and what are its implications for the natural history of critical COVID-19?Study Design and MethodsThis is a multicenter prospective cohort of critically ill patients with COVID-19. We performed serial echocardiography and lower extremity vascular ultrasound on hospitalization days 1, 3, and 8. We defined left ventricular (LV) dysfunction as the absolute value of longitudinal strain of < 17% or left ventricle ejection fraction (LVEF) of < 50%. Primary clinical outcome was inpatient survival.ResultsWe enrolled 110 patients. Thirty-nine (35.5%) died before hospital discharge. LV dysfunction was present at admission in 38 patients (34.5%) and in 21 patients (36.2%) on day 8 (P = .59). Median baseline LVEF was 62% (interquartile range [IQR], 52%-69%), whereas median absolute value of baseline LV strain was 16% (IQR, 14%-19%). Survivors and nonsurvivors did not differ statistically significantly with respect to day 1 LV strain (17.9% vs 14.4%; P = .12) or day 1 LVEF (60.5% vs 65%; P = .06). Nonsurvivors showed worse day 1 right ventricle (RV) strain than survivors (16.3% vs 21.2%; P = .04).InterpretationAmong patients with critical COVID-19, LV and RV dysfunction is common, frequently identified only through deformation imaging, and early (day 1) RV dysfunction may be associated with clinical outcome.