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Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients

Background: RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in...

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Autores principales: Zhang, Yanting, Sun, Wei, Wu, Chun, Zhang, Yiwei, Cui, Li, Xie, Yuji, Wang, Bin, He, Lin, Yuan, Hongliang, Zhang, Yongxing, Cai, Yu, Li, Meng, Zhang, Yu, Yang, Yun, Li, Yuman, Wang, Jing, Yang, Yali, Lv, Qing, Zhang, Li, Xie, Mingxing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902006/
https://www.ncbi.nlm.nih.gov/pubmed/33634177
http://dx.doi.org/10.3389/fcvm.2021.641088
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author Zhang, Yanting
Sun, Wei
Wu, Chun
Zhang, Yiwei
Cui, Li
Xie, Yuji
Wang, Bin
He, Lin
Yuan, Hongliang
Zhang, Yongxing
Cai, Yu
Li, Meng
Zhang, Yu
Yang, Yun
Li, Yuman
Wang, Jing
Yang, Yali
Lv, Qing
Zhang, Li
Xie, Mingxing
author_facet Zhang, Yanting
Sun, Wei
Wu, Chun
Zhang, Yiwei
Cui, Li
Xie, Yuji
Wang, Bin
He, Lin
Yuan, Hongliang
Zhang, Yongxing
Cai, Yu
Li, Meng
Zhang, Yu
Yang, Yun
Li, Yuman
Wang, Jing
Yang, Yali
Lv, Qing
Zhang, Li
Xie, Mingxing
author_sort Zhang, Yanting
collection PubMed
description Background: RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in coronavirus disease 2019 (COVID-19) remains unknown. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients. Methods: A cohort of 128 COVID-19-confirmed patients who had undergone echocardiography were studied. Thirty-one healthy volunteers were also enrolled as controls. COVID-19 patients were divided into three subgroups (general, severe, and critical) according to COVID-19 severity-of-illness. Conventional RV structure and function parameters, RV free wall longitudinal strain (FWLS) and 3D-RVEF were acquired. RVFWLS was measured by two-dimensional speckle tracking echocardiography. RVEF was acquired by 3DE. Results: Compared with controls, 2D-RVFWLS and 3D-RVEF were both significantly decreased in COVID-19 patients (−27.2 ± 4.4% vs. −22.9 ± 4.8%, P < 0.001; 53.7 ± 4.5% vs. 48.5 ± 5.8%, P < 0.001). Critical patients were more likely to have a higher incidence of acute cardiac injury and acute respiratory distress syndrome (ARDS), and worse prognosis than general and severe patients. The critical patients exhibited larger right-heart chambers, worse RV fractional area change (RVFAC), 2D-RVFWLS, and 3D-RVEF and higher proportion of pulmonary hypertension than general and severe patients. Eighteen patients died during a median follow-up of 91 days. The multivariate Cox regression analysis revealed the acute cardiac injury, ARDS, RVFAC, RVFWLS, and 3D-RVEF were independent predictors of death. 3D-RVEF (chi-square to improve 18.3; P < 0.001), RVFAC (chi-square to improve 4.5; P = 0.034) and 2D-RVFWLS (chi-square to improve 5.1; P = 0.024) all provided additional prognostic value of higher mortality over clinical risk factors. Moreover, the incremental predictive value of 3D-RVEF was significantly (P < 0.05) higher than RVFAC and RVFWLS. Conclusion: 3D-RVEF was the most robust independent predictor of mortality in COVID-19 patients and provided a higher predictive value over conventional RV function parameters and RVFWLS, which may be helpful to identify COVID-19 patients at a higher risk of death.
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spelling pubmed-79020062021-02-24 Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients Zhang, Yanting Sun, Wei Wu, Chun Zhang, Yiwei Cui, Li Xie, Yuji Wang, Bin He, Lin Yuan, Hongliang Zhang, Yongxing Cai, Yu Li, Meng Zhang, Yu Yang, Yun Li, Yuman Wang, Jing Yang, Yali Lv, Qing Zhang, Li Xie, Mingxing Front Cardiovasc Med Cardiovascular Medicine Background: RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in coronavirus disease 2019 (COVID-19) remains unknown. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients. Methods: A cohort of 128 COVID-19-confirmed patients who had undergone echocardiography were studied. Thirty-one healthy volunteers were also enrolled as controls. COVID-19 patients were divided into three subgroups (general, severe, and critical) according to COVID-19 severity-of-illness. Conventional RV structure and function parameters, RV free wall longitudinal strain (FWLS) and 3D-RVEF were acquired. RVFWLS was measured by two-dimensional speckle tracking echocardiography. RVEF was acquired by 3DE. Results: Compared with controls, 2D-RVFWLS and 3D-RVEF were both significantly decreased in COVID-19 patients (−27.2 ± 4.4% vs. −22.9 ± 4.8%, P < 0.001; 53.7 ± 4.5% vs. 48.5 ± 5.8%, P < 0.001). Critical patients were more likely to have a higher incidence of acute cardiac injury and acute respiratory distress syndrome (ARDS), and worse prognosis than general and severe patients. The critical patients exhibited larger right-heart chambers, worse RV fractional area change (RVFAC), 2D-RVFWLS, and 3D-RVEF and higher proportion of pulmonary hypertension than general and severe patients. Eighteen patients died during a median follow-up of 91 days. The multivariate Cox regression analysis revealed the acute cardiac injury, ARDS, RVFAC, RVFWLS, and 3D-RVEF were independent predictors of death. 3D-RVEF (chi-square to improve 18.3; P < 0.001), RVFAC (chi-square to improve 4.5; P = 0.034) and 2D-RVFWLS (chi-square to improve 5.1; P = 0.024) all provided additional prognostic value of higher mortality over clinical risk factors. Moreover, the incremental predictive value of 3D-RVEF was significantly (P < 0.05) higher than RVFAC and RVFWLS. Conclusion: 3D-RVEF was the most robust independent predictor of mortality in COVID-19 patients and provided a higher predictive value over conventional RV function parameters and RVFWLS, which may be helpful to identify COVID-19 patients at a higher risk of death. Frontiers Media S.A. 2021-02-09 /pmc/articles/PMC7902006/ /pubmed/33634177 http://dx.doi.org/10.3389/fcvm.2021.641088 Text en Copyright © 2021 Zhang, Sun, Wu, Zhang, Cui, Xie, Wang, He, Yuan, Zhang, Cai, Li, Zhang, Yang, Li, Wang, Yang, Lv, Zhang and Xie. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Zhang, Yanting
Sun, Wei
Wu, Chun
Zhang, Yiwei
Cui, Li
Xie, Yuji
Wang, Bin
He, Lin
Yuan, Hongliang
Zhang, Yongxing
Cai, Yu
Li, Meng
Zhang, Yu
Yang, Yun
Li, Yuman
Wang, Jing
Yang, Yali
Lv, Qing
Zhang, Li
Xie, Mingxing
Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients
title Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients
title_full Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients
title_fullStr Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients
title_full_unstemmed Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients
title_short Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients
title_sort prognostic value of right ventricular ejection fraction assessed by 3d echocardiography in covid-19 patients
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902006/
https://www.ncbi.nlm.nih.gov/pubmed/33634177
http://dx.doi.org/10.3389/fcvm.2021.641088
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