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Journal of the American Society of Echocardiography

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Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study - 03/08/21

Doi : 10.1016/j.echo.2021.05.010 
Ilya Karagodin, MD a, Cristiane Carvalho Singulane, MD a, Gary M. Woodward, PhD b, Mingxing Xie, MD, PhD, FASE c, Edwin S. Tucay, MD, FASE d, Ana C. Tude Rodrigues, MD e, Zuilma Y. Vasquez-Ortiz, MD, PhD f, Azin Alizadehasl, MD, FASE g, Mark J. Monaghan, PhD h, Bayardo A. Ordonez Salazar, MD i, Laurie Soulat-Dufour, MD j, Atoosa Mostafavi, MD k, Antonella Moreo, MD l, Rodolfo Citro, MD m, Akhil Narang, MD n, Chun Wu, MD, PhD c, Tine Descamps, PhD b, Karima Addetia, MD, FASE a, Roberto M. Lang, MD, FASE a, Federico M. Asch, MD, FASE o, ⁎
on behalf of the

WASE-COVID Investigators1

  A full list of additional WASE-COVID investigators is provided after the conclusion.
Vince Ryan V. Munoz, MD, Rafael Porto De Marchi, MD, Sergio M. Alday-Ramirez, PhD, Consuelo Orihuela, MD, Anita Sadeghpour, MD, FASE, Jonathan Breeze, MD, Amy Hoare, Carlos Ixcanparij Rosales, MD, Ariel Cohen, MD, Martina Milani, MD, Ilaria Trolese, RDCS, Oriana Belli, MD, Benedetta De Chiara, MD, Michele Bellino, MD, Giuseppe Iuliano, MD

a University of Chicago, Chicago, Illinois 
b Ultromics Ltd, Oxford, UK 
c Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, P.R. of China 
d Philippine Heart Center, Quezon City, Philippines 
e Radiology institute of the University of Sao Paulo Medical School, São Paulo, Brazil 
f Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran (INCMNSZ), Ciudad de Mexico, Mexico 
g Rajaie Cardiovascular Medical and Research Center, Echocardiography Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran 
h King's College Hospital, London, UK 
i Centro Medico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Ciudad de Mexico, Mexico 
j Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, FR 
k Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran 
l De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy 
m University of Salerno, Salerno, Italy 
n Northwestern University, Chicago, Illinois 
o MedStar Health Research Institute, Washington District of Columbia 

∗Reprint requests: Federico M. Asch, MD, FASE, 100 Irving Street, NW, Suite EB 5123, Washington, DC 20010100 Irving Street, NWSuite EB 5123Washington, DC20010
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Abstract

Background

The novel severe acute respiratory syndrome coronavirus-2 virus, which has led to the global coronavirus disease-2019 (COVID-19) pandemic is known to adversely affect the cardiovascular system through multiple mechanisms. In this international, multicenter study conducted by the World Alliance Societies of Echocardiography, we aim to determine the clinical and echocardiographic phenotype of acute cardiac disease in COVID-19 patients, to explore phenotypic differences in different geographic regions across the world, and to identify parameters associated with in-hospital mortality.

Methods

We studied 870 patients with acute COVID-19 infection from 13 medical centers in four world regions (Asia, Europe, United States, Latin America) who had undergone transthoracic echocardiograms. Clinical and laboratory data were collected, including patient outcomes. Anonymized echocardiograms were analyzed with automated, machine learning–derived algorithms to calculate left ventricular (LV) volumes, ejection fraction, and LV longitudinal strain (LS). Right-sided echocardiographic parameters that were measured included right ventricular (RV) LS, RV free-wall strain (FWS), and RV basal diameter. Multivariate regression analysis was performed to identify clinical and echocardiographic parameters associated with in-hospital mortality.

Results

Significant regional differences were noted in terms of patient comorbidities, severity of illness, clinical biomarkers, and LV and RV echocardiographic metrics. Overall in-hospital mortality was 21.6%. Parameters associated with mortality in a multivariate analysis were age (odds ratio [OR] = 1.12 [1.05, 1.22], P = .003), previous lung disease (OR = 7.32 [1.56, 42.2], P = .015), LVLS (OR = 1.18 [1.05, 1.36], P = .012), lactic dehydrogenase (OR = 6.17 [1.74, 28.7], P = .009), and RVFWS (OR = 1.14 [1.04, 1.26], P = .007).

Conclusions

Left ventricular dysfunction is noted in approximately 20% and RV dysfunction in approximately 30% of patients with acute COVID-19 illness and portend a poor prognosis. Age at presentation, previous lung disease, lactic dehydrogenase, LVLS, and RVFWS were independently associated with in-hospital mortality. Regional differences in cardiac phenotype highlight the significant differences in patient acuity as well as echocardiographic utilization in different parts of the world.

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Highlights

•
A total of 870 patients admitted with COVID-19 were enrolled in nine countries.
•
LV size and function were analyzed by a core lab and AI.
•
LV and RV dysfunction are common in acute COVID-19 illness and portend a poor prognosis.
•
Age, lung disease, LDH, LVLS, and RVFWS were associated with in-hospital mortality.
•
World regional LV/RV differences highlight differences in patient acuity and echo utilization.

Le texte complet de cet article est disponible en PDF.

Keywords : Echocardiography, WASE, International, COVID-19, Mortality, Strain

Abbreviations : 2CH, 4CH, ACC, AI, ASE, AUC, BNP, COVID-19, CRP, EF, EACVI, FWS, ICU, LDH, LV, LS, LVEDV, LVEF, LVESV, LVLS, MICE, OR, Q1, Q3, ROC, RV, RVBD, RVFWS, RVLS, SARS-CoV-2, TTE, ULN, WASE


Plan


 Conflicts of Interests: G.M.W. and T.D. are employees of Ultromics. M.J.M. is on the advisory board and speaker's bureau for Bracco and Philips. R.M.L. is on the advisory board and speaker's bureau for Philips and the advisory board for Caption Health. F.M.A. received institutional (MedStar Health) research grants from TOMTEC, Ultromics, GE, and Caption Health and nonpaid scientific advisory committee for Ultromics. All other authors have no conflicts to disclose related to this work.
 This work was supported by the American Society of Echocardiography Foundation, University of Chicago, and MedStar Health with in-kind support from Ultromics and TOMTEC.


© 2021  American Society of Echocardiography. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 34 - N° 8

P. 819-830 - août 2021 Retour au numéro
Article précédent Article précédent
  • The Utility of Myocardial Work in Clinical Practice
  • Sarah Roemer, Akshar Jaglan, David Santos, Matthew Umland, Renuka Jain, A. Jamil Tajik, Bijoy K. Khandheria
| Article suivant Article suivant
  • Determining Which Hospitalized Coronavirus Disease 2019 Patients Require Urgent Echocardiography
  • Neal Yuan, Stephanie Wu, Florian Rader, Robert J. Siegel

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