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
on behalf of the
WASE-COVID Investigators1
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.
Le texte complet de cet article est disponible en PDF.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. |
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. |
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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. |
Vol 34 - N° 8
P. 819-830 - août 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.