Introduction: The coronavirus disease 2019 (COVID-19) is known to cause right ventricular (RV) dysfunction. While conventional parameters of RV function may prove to be less precise, more variable, and less sensitive to predict the requirement of mechanical ventilation (MV), noninvasive ventilation (NIV) and 30-day mortality, speckle tracking echocardiography may indicate RV dysfunction early in the course of the disease. This study was aimed to determine if RV strain parameters have greater accuracy for the prediction of the requirement of MV, NIV, and mortality compared to conventional indices of RV function.
Materials: Point of care echocardiographic assessment was conducted bedside on the day of admission to the intensive care unit (ICU) on 101 subjects suffering from COVID-19. Conventional parameters included tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), and left ventricular (LV) ejection fraction (LVEF) and advanced echocardiographic parameters namely RV free wall strain length (RVFWSL) and RV 4-chamber strain length (RV4CSL) were used to assess RV function.
Results: The RVFWSL was −16.15 (±3.29) in nonsurvivors compared to −24.94 (±5.62) in survivors. A similar trend was noticed in RV4CSL which was −13.61 (±5.30) in nonsurvivors when compared to survivors (−22.37 ± 4.56). Receiver operating characteristic (ROC) area under the curve (AUC) for predicting the need for NIV, MV, and mortality was plotted for both the strain and conventional echo parameters.
The AUC values predicting the requirement of NIV were 0.92 (0.86–0.97), 0.91 (0.85–0.96), 0.14 (0.07–0.21), 0.18 (0.10–0.27), and 0.14 (0.06–0.22); (p < 0.001 for all parameters) for RVFWSL, RV4CSL, TAPSE, RVEF, and LVEF, respectively. The AUC values for predicting the requirement of MV were 0.90 (0.84–0.97), 0.92 (0.87–0.97), 0.10 (0.03–0.16), 0.09 (0.03–0.15), and 0.10 (0.04–0.16); (p < 0.001 for all parameters) with respect to RVFWSL, RV4CSL, TAPSE, RVEF, and LVEF, respectively. The AUC values for predicting mortality were 0.90 (0.84–0.97), 0.93 (0.88–0.97), 0.12 (0.05–0.19), 0.09 (0.03–0.15), and 0.09 (0.03–0.15); (p < 0.01) with respect to RVFWSL, RV4CSL, TAPSE, RVEF, and LVEF, respectively.
Conclusion: The RV strain parameters namely RVFWSL and RV4CSL were significantly better predictors of MV, NIV, and 30-day mortality in patients admitted to COVID ICU.
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