Early Serial Echocardiographic and Ultrasonographic Findings in Critically Ill Patients With COVID-19

• DOI: 10.1016/j.chstcc.2023.100002
• Publication Date: 2023-03-22T07:56:53Z
• Authors: Michael J. Lanspa; Siddharth P. Dugar; Heather L. Prigmore; Jeremy S. Boyd; Jordan D. Rupp; Chris J. Lindsell; Todd W. Rice; Nida Qadir; George W. Lim; Ariel L. Shiloh; Vladyslav Dieiev; Michelle N. Gong; Steven W. Fox; Eliotte L. Hirshberg; Akram Khan; James Kornfield; Jacob H. Schoeneck; Nicholas Macklin; D.Clark Files; Kevin W. Gibbs; Matthew E. Prekker; Daniel Parsons-Moss; Mikaele Bown; Troy D. Olsen; Daniel B. Knox; Meghan M. Cirulis; Omar Mehkri; Abhijit Duggal; Mark W. Tenforde; Manish M. Patel; Wesley H. Self; Samuel M. Brown; Nicole Calhoun; Judy Herrick; Eric Hoffman; Amanda McKillop; Kempapura Murthy; Michael Smith; Martha Zayed; Lesley De Souza; Ryan Kindle; Lori-Ann Kozikowski; Scott Ouellette; Sherell Thornton-...; Michael Bolstad; Robert Ciottone; Brianna Coviello; Arnaldo Devilla; Ana Grafals; Conor Higgins; Carlo Ottanelli; Kimberly Redman; Douglas Scaffidi; Alexander Weingart; Nathaniel Lewis; Samantha Olson; Kiran Ashok; Connery Brennan; Omar Mehkri; Megan Mitchell; Bryan Poynter; Nicholas Stanley; Caitlin ten Lohuis; Sean Caspers; Heidi Erikson; Audrey Hendrickson; Olivia Kaus; Ellen Maruggi; Tyler Scharber; Walker Tordsen; Valerie Aston; Robert Bowers; Jeffrey Jorgensen; Jennifer King; Harith Ali; Richard E. Rothman; Rahul Nair; Jen-Ting Chen; Sarah Karow; Emily Robart; Paulo Nunes Maldo...; Maryiam Khan; Preston So; Elizabeth Schwartz; Madison So; Michael Weigand; Andrea Luong; Jesus Martinez; Bao Huynh; Habiba Ibrahim; Cynthia Villanuev...; Haeun Jung; Juliana Villanuev...; Suha Quadri; Alexandra Jun Gordon; Joe Levitt; Cynthia Perez; Anita Visweswaran; Jonasel Roque; Adreanne Rivera; Trevor Frankel; Jennifer Goff; David Huynh; Kelly Jensen; Conner Driver; Ian Chambers; Paul Nassar; Lori Stout; Zita Sibenaller; Alicia Walter; Jasmine Mares; Logan Olson; Bradley Clinansmith; Hayley Gershengorn; Carolina Rivas; E.J. McSpadden; Rachel Truscon; Anne Kaniclides; Lara Thomas; Ramsay Bielak; Weronika Damek Va...; Rebecca Fong; William J. Fitzsi...; Christopher Blair; Andrew Valesano; Leigh Baker; Julie Gilbert; Christine D. Crider; Kyle A. Steinbock; Thomas C. Paulson; Layla A. Anderson; Christy Kampe; Jakea Johnson; Laura L. Short; Lauren J. Ezzell; Margaret E. Whitsett; Rendie E. McHenry; Samarian J. Hargrave; Marica Blair; Jennifer L. Luther; Claudia Guevara P...; Bryan P.M. Peterson; Mary LaRose; Leigha Landreth; Madeline Hicks; Lisa Parks; Jahnavi Bongu; David McDonald; Candice Cass; Sondra Seiler; David Park; Tiffany Hink; Meghan Wallace; Carey-Ann Burnham; Olivia G. Arter
• Keywords: strain; ultrasound; COVID-19; echocardiography; Sepsis and Infections: Original Research; point-of-care ultrasound; 3. Good health

Cardiac function of critically ill patients with COVID-19 generally has been reported from clinically obtained data. Echocardiographic deformation imaging can identify ventricular dysfunction missed by traditional echocardiographic assessment.What is the prevalence of ventricular dysfunction and what are its implications for the natural history of critical COVID-19?This is a multicenter prospective cohort of critically ill patients with COVID-19. We performed serial echocardiography and lower extremity vascular ultrasound on hospitalization days 1, 3, and 8. We defined left ventricular (LV) dysfunction as the absolute value of longitudinal strain of < 17% or left ventricle ejection fraction (LVEF) of < 50%. Primary clinical outcome was inpatient survival.We enrolled 110 patients. Thirty-nine (35.5%) died before hospital discharge. LV dysfunction was present at admission in 38 patients (34.5%) and in 21 patients (36.2%) on day 8 (P = .59). Median baseline LVEF was 62% (interquartile range [IQR], 52%-69%), whereas median absolute value of baseline LV strain was 16% (IQR, 14%-19%). Survivors and nonsurvivors did not differ statistically significantly with respect to day 1 LV strain (17.9% vs 14.4%; P = .12) or day 1 LVEF (60.5% vs 65%; P = .06). Nonsurvivors showed worse day 1 right ventricle (RV) strain than survivors (16.3% vs 21.2%; P = .04).Among patients with critical COVID-19, LV and RV dysfunction is common, frequently identified only through deformation imaging, and early (day 1) RV dysfunction may be associated with clinical outcome.