期刊
REVISTA DA SOCIEDADE BRASILEIRA DE MEDICINA TROPICAL
卷 54, 期 -, 页码 -出版社
SOC BRASILEIRA MEDICINA TROPICAL
DOI: 10.1590/0037-8682-0382-2021
关键词
COVID-19; Echocardiography; Prognosis; SARS-Cov-2; Mortality
资金
- Edwards Lifesciences Foundation(R), US
- FAPEMIG (Fundacao de Amparo a Pesquisa do Estado de Minas Gerais, grant Selecao SEDE/FAPEMIG) [APQ-000627-20]
- State Government of Minas Gerais
- Health Department (Secretaria de Estado da Saude de Minas Gerais)
- FAPEMIG (Fundacao de Amparo a Pesquisa de Minas Gerais)
- Brazilian Government
- Health Ministry
- Science and Technology Ministry
- CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico) e FINEP (Financiadora de Estudos e Projetos)
- CNPq [310679/2016-8, 465518/2014-1, 312382/2019-7]
- FAPEMIG [APQ-000627-20, PPM-00428-17, RED-00081-16]
- CAPES [88887.507149/2020-00]
- National Institute of Science and Technology for Health Technology Assessment (IATS) [465518/2014-1]
Cardiac involvement appears to impact prognosis of COVID-19, especially in critically ill patients. This study found that markers of right ventricular (RV) and left ventricular (LV) dysfunction assessed by bedside echocardiography are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.
Introduction: Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. Methods: Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. Results: Total 163 patients were enrolled, 59% were men, mean age 64 +/- 16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age >= 63 years (OR=5.53, 95%CI 1.52- 20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). Conclusion: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.
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