Incremental prognostic value of biventricular longitudinal strain and high-sensitivity troponin I in COVID-19 patients

Wei Sun; Yanting Zhang; Chun Wu; Yuji Xie; Li Peng; Xiu Nie; Cheng Yu; Yi Zheng; Yuman Li; Jing Wang; Yali Yang; Qing Lv; Li Zhang; Cynthia C Taub; Mingxing Xie

doi:10.1111/echo.15133

Incremental prognostic value of biventricular longitudinal strain and high-sensitivity troponin I in COVID-19 patients

Echocardiography. 2021 Aug;38(8):1272-1281. doi: 10.1111/echo.15133. Epub 2021 Jun 29.

Authors

Wei Sun^{1

2

3}, Yanting Zhang^{1

2

3}, Chun Wu^{1

2

3}, Yuji Xie^{1

2

3}, Li Peng⁴, Xiu Nie⁴, Cheng Yu^{1

2

3}, Yi Zheng^{1

2

3}, Yuman Li^{1

2

3}, Jing Wang^{1

2

3}, Yali Yang^{1

2

3}, Qing Lv^{1

2

3}, Li Zhang^{1

2

3}, Cynthia C Taub⁵, Mingxing Xie^{1

2

3}

Affiliations

¹ Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.
³ Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
⁴ Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁵ Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.

Abstract

Background: Whether the combination of ventricular strain with high-sensitivity troponin I (hs-TNI) has an incremental prognostic value in coronavirus disease 2019 (COVID-19) patients has not been evaluated. The study aimed to evaluate the prognostic value of biventricular longitudinal strain and its combination with hs-TNI in COVID-19 patients.

Methods: A total of 160 COVID-19 patients who underwent both echocardiography and hs-TNI testing were enrolled in our study. COVID-19 patients were divided into two groups (critical and non-critical) according to severity-of-illness. The clinical characteristics, cardiac structure and function were compared between the two groups. The prognostic value of biventricular longitudinal strain and its combination with hs-TNI were evaluated by logistic regression analyses and receiver operating characteristic curves. Left ventricular longitudinal strain (LV LS) and right ventricular free wall longitudinal strain (RVFWLS) were determined by 2D speckle-tracking echocardiography.

Results: The LV LS and RVFWLS both were significantly lower in critical patients than non-critical patients (LV LS: -16.6±2.4 vs -17.9±3.0, P = .003; RVFWLS :-18.8±3.6 vs -23.9±4.4, P<.001). During a median follow-up of 60 days, 23 (14.4%) patients died. The multivariant analysis revealed that LV LS and RVFWLS [Odd ratio (95% confidence interval): 1.533 (1.131-2.079), P = .006; 1.267 (1.036-1.551), P = .021, respectively] were the independent predictors of higher mortality. Further, receiver-operating characteristic analysis revealed that the accuracy for predicting death was greater for the combination of hs-TNI levels with LV LS than separate LV LS (AUC: .91 vs .77, P = .001), and the combination of hs-TNI levels with RVFWLS than RVFWLS alone (AUC: .89 vs .83, P = .041).

Conclusions: Our study highlights that the combination of ventricular longitudinal strain with hs-TNI can provide higher accuracy for predicting mortality in COVID-19 patients, which may enhance risk stratification in COVID-19 patients.

Keywords: COVID-19; biventricular strain; high-sensitivity troponin I; speckle-tracking echocardiography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Echocardiography
Humans
Prognosis
SARS-CoV-2
Troponin I*

Substances

Troponin I

Abstract

Publication types

MeSH terms

Substances

Grants and funding