Echocardiographic predictors of mortality in COVID-19
As mentioned earlier, elevated PASP has been found to be associated with higher in-hospital mortality[18]. Studies have consistently shown RV dysfunction to be a predictor of disease severity. Mortality rate has been found to be increased in patients with moderate/severe dilation of the RV as compared to patients with mild/no RV dilation[21]. One study showed RV dilatation correlates with high sensitivity troponins, and d-Dimer levels [44]. Decrease in RV global longitudinal strain (GLS) and TAPSE were found to be strong predictive factors of mortality in COVID-19 patients[45,46]. Of note, decreased RVGLS and RV free wall longitudinal strain (RVFWLS) have been found to predict mortality independent of respiratory parameters, LV function or markers of multi-organ failure[19,45,47]. In addition, oxygen need, higher d-Dimer and C-reactive protein (CRP) correlated with lower RVGLS [19,45,47]. A cut-off of -23% was found to have a sensitivity of 94 % for predicting mortality[45]. In another study of 35 patients, those with RVGLS less than -20% had significantly higher 30 day mortality [48].
With regards to LV parameters, mortality was found to be increased in patients who had reduced LV longitudinal strain (LS), left ventricular stroke volume index (LVSVi), cardiac index and tissue Doppler S’ (systolic wave) velocity[46]. In addition, Giustino et al. demonstrated that the mortality rate in patients with myocardial injury, defined as elevated cardiac biomarkers, was higher in patients with evidence of WMAs as compared to those without WMAs[33].