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

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  • 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
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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 languageEnglish
JournalESC Heart Failure
Issue number6
Pages (from-to)4189-4197
Publication statusPublished - Dec 2020

    Research areas

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

ID: 61083432