FOCUSED ECHOCARDIOGRAPHY FOR REDEFINING THE PROGNOSIS OF PATIENTS HOSPITALIZED WITH COVID-19 BEYOND CLINICAL DATA - DATA FROM THE PROVAR-COVID STUDY

Background

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 focused echocardiography (echo), in patients hospitalized with COVID-19.

Methods

The PROVAR+ study utilizes simplified protocols for imaging acquisition, and telemedicine interpretation for cardiovascular screening. Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate and severe presentations - according to the Berlin criteria - underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid IQ), at the earliest convenience, with remote interpretation. The association between demographics (age, sex), clinical comorbidities and echo variables (RV and LV function) with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable proportional Cox models.

Results

Total 163 patients were consecutively enrolled, mean age was 64±16 years, 96 (59%) were men and 107 (66%) had severe disease with admission 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 RV and LV function variables significantly associated with death: LV ejection fraction (LVEF, HR: 0.94), RV fractional area change (HR: 0.96), tricuspid annular plane systolic excursion (TAPSE, HR: 0.83) and subjective RV dysfunction (HR: 5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age (HR: 1.05, 95% CI 1.01 - 1.10, p=0.023), LVEF (HR: 0.95, 95% CI 0.91 - 1.00, p=0.48) and TAPSE (HR: 0.76, 95% CI 0.63 - 0.91, p=0.005). The final model had good performance, with C-statistic = 0.78 (95% CI 0.68 - 0.88).

Conclusion

Markers of RV and LV dysfunction are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables. Focused echo may be used early following admission for more refined risk stratification.