Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

Arief Wibowo; Raymond Pranata; Astri Astuti; Badai Bhatara Tiksnadi; Erwan Martanto; Januar Wibawa Martha; Augustine Purnomowati; Mohammad Rizki Akbar

doi:10.1186/s40560-020-00519-3

Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

J Intensive Care. 2021 Jan 12;9(1):9. doi: 10.1186/s40560-020-00519-3.

Authors

Arief Wibowo¹, Raymond Pranata^{1

2}, Astri Astuti¹, Badai Bhatara Tiksnadi¹, Erwan Martanto¹, Januar Wibawa Martha¹, Augustine Purnomowati¹, Mohammad Rizki Akbar³

Affiliations

¹ Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Jalan Professor Eyckman No.38, Pasteur, Bandung, Jawa Barat, 40161, Indonesia.
² Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
³ Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Jalan Professor Eyckman No.38, Pasteur, Bandung, Jawa Barat, 40161, Indonesia. m.r.akbar@unpad.ac.id.

Abstract

Background: This systematic review and meta-analysis aimed to assess whether ventricular longitudinal strain can be used as a prognostication tool in patients with coronavirus disease 2019 (COVID-19).

Methods: Systematic literature searches of PubMed, Embase, and EuropePMC databases were performed on 16 November 2020. Left ventricular global longitudinal strain (LV-GLS) refers to LV contraction measurement using the speckle tracking-based method refers to the mean of strain values of the RV free wall (three segments) measured using echocardiography. The main outcome was poor outcome, defined as a composite of mortality and severe COVID-19.

Results: Seven studies comprising of 612 patients were included in meta-analysis. Six studies have mortality as their outcome, and 1 study has severity as their outcome. Patients with poor outcome have lower LV-GLS (SMD 1.15 (0.57, 1.72), p < 0.001; I² 70.4%). Each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome (OR 1.37 (1.12, 1.67), p = 0.002; I² 48.8%). Patients with poor outcome have lower RV-LS (SMD 1.18 (0.91, 1.45), p < 0.001; I² 0%). Each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome (OR 1.25 (1.15, 1.35), p < 0.001; I² 11.8%). Subgroup analysis showed that for every 1% decrease in LV-GLS and RV-LS is increased mortality with OR of 1.30 (1.12, 1.50) and OR of 1.24 (1.14, 1.35), respectively.

Conclusion: This study shows that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19.

Trial registration: PROSPERO CRD42020221144.

Keywords: COVID-19; Echocardiography; Longitudinal strain; SARS-CoV-2; Ventricle.