Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study

Mats Christian Højbjerg Lassen; Kristoffer Grundtvig Skaarup; Jannie Nørgaard Lind; Alia Saed Alhakak; Morten Sengeløv; Anne Bjerg Nielsen; Caroline Espersen; Kirstine Ravnkilde; Raphael Hauser; Liv Borum Schöps; Eva Holt; Niklas Dyrby Johansen; Daniel Modin; Kasper Djernaes; Claus Graff; Henning Bundgaard; Christian Hassager; Reza Jabbari; Jørn Carlsen; Anne-Mette Lebech; Ole Kirk; Uffe Bodtger; Matias Greve Lindholm; Gowsini Joseph; Lothar Wiese; Frank Vinholt Schiødt; Ole Peter Kristiansen; Emil Schwarz Walsted; Olav Wendelboe Nielsen; Birgitte Lindegaard Madsen; Niels Tønder; Thomas Benfield; Klaus Nielsen Jeschke; Charlotte Suppli Ulrik; Filip Knop; Morten Lamberts; Pradeesh Sivapalan; Gunnar Gislason; Jacob Louis Marott; Rasmus Møgelvang; Gorm Jensen; Peter Schnohr; Peter Søgaard; Scott D Solomon; Kasper Iversen; Jens Ulrik Staehr Jensen; Morten Schou; Tor Biering-Sørensen

doi:10.1002/ehf2.13044

Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study

Mats Christian Højbjerg Lassen, Kristoffer Grundtvig Skaarup, Jannie Nørgaard Lind, Alia Saed Alhakak, Morten Sengeløv, Anne Bjerg Nielsen, Caroline Espersen, Kirstine Ravnkilde, Raphael Hauser, Liv Borum Schöps, Eva Holt, Niklas Dyrby Johansen, Daniel Modin, Kasper Djernaes, Claus Graff, Henning Bundgaard, Christian Hassager, Reza Jabbari, Jørn Carlsen, Anne-Mette LebechOle Kirk, Uffe Bodtger, Matias Greve Lindholm, Gowsini Joseph, Lothar Wiese, Frank Vinholt Schiødt, Ole Peter Kristiansen, Emil Schwarz Walsted, Olav Wendelboe Nielsen, Birgitte Lindegaard Madsen, Niels Tønder, Thomas Benfield, Klaus Nielsen Jeschke, Charlotte Suppli Ulrik, Filip Knop, Morten Lamberts, Pradeesh Sivapalan, Gunnar Gislason, Jacob Louis Marott, Rasmus Møgelvang, Gorm Jensen, Peter Schnohr, Peter Søgaard, Scott D Solomon, Kasper Iversen, Jens Ulrik Staehr Jensen, Morten Schou, Tor Biering-Sørensen

77 Citations (Scopus)

Abstract

AIMS: The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death.

METHODS AND RESULTS: In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease.

CONCLUSIONS: RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.

Original language	English
Journal	ESC Heart Failure
Volume	7
Issue number	6
Pages (from-to)	4189-4197
ISSN	2055-5822
DOIs	https://doi.org/10.1002/ehf2.13044
Publication status	Published - Dec 2020

Keywords

COVID-19
Echocardiography
Global longitudinal strain
Right ventricular strain
SARS-CoV-2

Access to Document

10.1002/ehf2.13044

Cite this

Lassen, M. C. H., Skaarup, K. G., Lind, J. N., Alhakak, A. S., Sengeløv, M., Nielsen, A. B., Espersen, C., Ravnkilde, K., Hauser, R., Schöps, L. B., Holt, E., Johansen, N. D., Modin, D., Djernaes, K., Graff, C., Bundgaard, H., Hassager, C., Jabbari, R., Carlsen, J., ... Biering-Sørensen, T. (2020). Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study. ESC Heart Failure, 7(6), 4189-4197. https://doi.org/10.1002/ehf2.13044

Lassen, MCH, Skaarup, KG, Lind, JN, Alhakak, AS , Sengeløv, M , Nielsen, AB , Espersen, C , Ravnkilde, K, Hauser, R, Schöps, LB, Holt, E, Johansen, ND , Modin, D, Djernaes, K, Graff, C, Bundgaard, H , Hassager, C , Jabbari, R , Carlsen, J , Lebech, A-M , Kirk, O, Bodtger, U, Lindholm, MG, Joseph, G, Wiese, L, Schiødt, FV , Kristiansen, OP , Walsted, ES , Nielsen, OW , Madsen, BL , Tønder, N , Benfield, T , Jeschke, KN , Ulrik, CS , Knop, F , Lamberts, M , Sivapalan, P , Gislason, G , Marott, JL , Møgelvang, R, Jensen, G, Schnohr, P, Søgaard, P, Solomon, SD, Iversen, K , Jensen, JUS , Schou, M & Biering-Sørensen, T 2020, 'Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study', ESC Heart Failure, vol. 7, no. 6, pp. 4189-4197. https://doi.org/10.1002/ehf2.13044

@article{63a398c2ed0a4baeab3f281d073ad8b2,

title = "Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study",

abstract = "AIMS: The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death.METHODS AND RESULTS: In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease.CONCLUSIONS: RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.",

keywords = "COVID-19, Echocardiography, Global longitudinal strain, Right ventricular strain, SARS-CoV-2",

author = "Lassen, {Mats Christian H{\o}jbjerg} and Skaarup, {Kristoffer Grundtvig} and Lind, {Jannie N{\o}rgaard} and Alhakak, {Alia Saed} and Morten Sengel{\o}v and Nielsen, {Anne Bjerg} and Caroline Espersen and Kirstine Ravnkilde and Raphael Hauser and Sch{\"o}ps, {Liv Borum} and Eva Holt and Johansen, {Niklas Dyrby} and Daniel Modin and Kasper Djernaes and Claus Graff and Henning Bundgaard and Christian Hassager and Reza Jabbari and J{\o}rn Carlsen and Anne-Mette Lebech and Ole Kirk and Uffe Bodtger and Lindholm, {Matias Greve} and Gowsini Joseph and Lothar Wiese and Schi{\o}dt, {Frank Vinholt} and Kristiansen, {Ole Peter} and Walsted, {Emil Schwarz} and Nielsen, {Olav Wendelboe} and Madsen, {Birgitte Lindegaard} and Niels T{\o}nder and Thomas Benfield and Jeschke, {Klaus Nielsen} and Ulrik, {Charlotte Suppli} and Filip Knop and Morten Lamberts and Pradeesh Sivapalan and Gunnar Gislason and Marott, {Jacob Louis} and Rasmus M{\o}gelvang and Gorm Jensen and Peter Schnohr and Peter S{\o}gaard and Solomon, {Scott D} and Kasper Iversen and Jensen, {Jens Ulrik Staehr} and Morten Schou and Tor Biering-S{\o}rensen",

note = "{\textcopyright}2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.",

year = "2020",

month = dec,

doi = "10.1002/ehf2.13044",

language = "English",

volume = "7",

pages = "4189--4197",

journal = "ESC Heart Failure",

issn = "2055-5822",

publisher = "JohnWiley & Sons Ltd",

number = "6",

}

TY - JOUR

T1 - Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients

T2 - the ECHOVID-19 study

AU - Lassen, Mats Christian Højbjerg

AU - Skaarup, Kristoffer Grundtvig

AU - Lind, Jannie Nørgaard

AU - Alhakak, Alia Saed

AU - Sengeløv, Morten

AU - Nielsen, Anne Bjerg

AU - Espersen, Caroline

AU - Ravnkilde, Kirstine

AU - Hauser, Raphael

AU - Schöps, Liv Borum

AU - Holt, Eva

AU - Johansen, Niklas Dyrby

AU - Modin, Daniel

AU - Djernaes, Kasper

AU - Graff, Claus

AU - Bundgaard, Henning

AU - Hassager, Christian

AU - Jabbari, Reza

AU - Carlsen, Jørn

AU - Lebech, Anne-Mette

AU - Kirk, Ole

AU - Bodtger, Uffe

AU - Lindholm, Matias Greve

AU - Joseph, Gowsini

AU - Wiese, Lothar

AU - Schiødt, Frank Vinholt

AU - Kristiansen, Ole Peter

AU - Walsted, Emil Schwarz

AU - Nielsen, Olav Wendelboe

AU - Madsen, Birgitte Lindegaard

AU - Tønder, Niels

AU - Benfield, Thomas

AU - Jeschke, Klaus Nielsen

AU - Ulrik, Charlotte Suppli

AU - Knop, Filip

AU - Lamberts, Morten

AU - Sivapalan, Pradeesh

AU - Gislason, Gunnar

AU - Marott, Jacob Louis

AU - Møgelvang, Rasmus

AU - Jensen, Gorm

AU - Schnohr, Peter

AU - Søgaard, Peter

AU - Solomon, Scott D

AU - Iversen, Kasper

AU - Jensen, Jens Ulrik Staehr

AU - Schou, Morten

AU - Biering-Sørensen, Tor

PY - 2020/12

Y1 - 2020/12

N2 - AIMS: The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death.METHODS AND RESULTS: In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease.CONCLUSIONS: RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.

AB - AIMS: The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death.METHODS AND RESULTS: In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease.CONCLUSIONS: RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.

KW - COVID-19

KW - Echocardiography

KW - Global longitudinal strain

KW - Right ventricular strain

KW - SARS-CoV-2

U2 - 10.1002/ehf2.13044

DO - 10.1002/ehf2.13044

M3 - Journal article

C2 - 33089972

SN - 2055-5822

VL - 7

SP - 4189

EP - 4197

JO - ESC Heart Failure

JF - ESC Heart Failure

IS - 6

ER -

Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study

Abstract

Keywords

Access to Document

Fingerprint

Cite this