Association of subclinical left ventricular systolic dysfunction detected on 2d echocardiogram global longitudinal strain and in-hospital adverse clinical outcomes in covid 19 patients
Authors: Ramos S Z , Putra H M , Locnen S A , Escasura G , Atutubo B K 
Published: November 2023

Abstract

Introduction
There are no standardized recommendations regarding the cardiovascular evaluation of patients hospitalized with COVID-19. Transthoracic echocardiography remains a useful imaging modality for patients with COVID-19. Normal left ventricular ejection fraction (LVEF) may not be a reliable parameter for the sole assessment of LV systolic function in COVID-19 patients. LV-GLS can evaluate subclinical impairment of myocardium earlier and more accurately as well as myocardial dysfunction than the conventional echocardiography.

Purpose
To determine the association of LV-GLS on transthoracic 2D echocardiogram (TTE) with heart failure, ACS and arrhythmia, length of hospital stay among patients with COVID-19.

Methods
This was a retrospective, analytical, observational, cross-sectional study involving COVID-19 patients admitted at a tertiray hospital who underwent transthoracic 2D echocardiographic examination with normal left ventricular systolic function.

Results
We analyzed 449 COVID-19 patients, in whom 253 patients had normal LV-GLS and 196 patients had abnormal LV-GLS. The mean age in years was 64 with male dominance (55.68 % vs 44.32%). There were more males in the abnormal LV-GLS group (61.22% vs 51.38%, p=.044). In terms of COVID-19 severity, many patients had severe infection (42.09%), while the rest had mild (4.9%), moderate (21.38%) and critical (31.63%) infection. Many patients also had abnormal BMI of 25-29.9 kg/m2 (40.09%). The top two most common comorbidities were hypertension and diabetes mellitus. Majority (89.09%) never smoked while for the 49 patients who were former/current smokers, their median cigarette consumption was 20 pack years. Most of the patients were taking maintenance medications (68.6%) and had COVID-19 medications (91.76%). The prevalence of subclinical left ventricular systolic dysfunction among patients with COVID-19 was 43.7% (95% CI [39.0% to 48.4%]). There is no evidence of acute myocardial infarction (OR 1.29, 95% CI 018-9.27, p = 0.79), overt left systolic dysfunction (OR 2.60, 95% CI 0.23-28.86, p = 0.437), or longer hospital stay (average 11 days [7-19] p = 0.830) among patients with abnormal LV-GLS. However, abnormal LV-GLS is associated with incidence of arrhythmias requiring intervention (OR 2.00, 95% CI 1.14-3.51, p = 0.015). Arrhythmia was associated with age, COVID-19 severity, and LV-GLS. For every unit increase in age, the odds of arrhythmia increase by 5% (aOR 1.02-1.08, p &lt; 0.001). Patients with critical COVID were about 18 times more likely to have an arrhythmia (aOR 17.94, 95% CI 5.21 -61.74, p&lt;.001), while those abnormal GLS were twice as likely to have arrhythmia (aOR 2.32, 95% CI 1.22-4.40, p = 0.01).

Conclusion
The prevalence of subclinical left ventricular systolic dysfunction in COVID-19 patients was at 43.7% which was significantly associated with arrhythmias requiring treatment. Age, COVID severity, obesity, and abnormal GLS were associated with COVID 19 mortality.Patient characteristic with mortalityPredictors of mortality