AUTHOR=Zhang Yanting , Sun Wei , Wu Chun , Zhang Yiwei , Cui Li , Xie Yuji , Wang Bin , He Lin , Yuan Hongliang , Zhang Yongxing , Cai Yu , Li Meng , Zhang Yu , Yang Yun , Li Yuman , Wang Jing , Yang Yali , Lv Qing , Zhang Li , Xie Mingxing 

TITLE=Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.641088

DOI=10.3389/fcvm.2021.641088

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in coronavirus disease 2019 (COVID-19) remains unknown. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients.</p><p><bold>Methods:</bold> A cohort of 128 COVID-19-confirmed patients who had undergone echocardiography were studied. Thirty-one healthy volunteers were also enrolled as controls. COVID-19 patients were divided into three subgroups (general, severe, and critical) according to COVID-19 severity-of-illness. Conventional RV structure and function parameters, RV free wall longitudinal strain (FWLS) and 3D-RVEF were acquired. RVFWLS was measured by two-dimensional speckle tracking echocardiography. RVEF was acquired by 3DE.</p><p><bold>Results:</bold> Compared with controls, 2D-RVFWLS and 3D-RVEF were both significantly decreased in COVID-19 patients (−27.2 ± 4.4% vs. −22.9 ± 4.8%, <italic>P</italic> &lt; 0.001; 53.7 ± 4.5% vs. 48.5 ± 5.8%, <italic>P</italic> &lt; 0.001). Critical patients were more likely to have a higher incidence of acute cardiac injury and acute respiratory distress syndrome (ARDS), and worse prognosis than general and severe patients. The critical patients exhibited larger right-heart chambers, worse RV fractional area change (RVFAC), 2D-RVFWLS, and 3D-RVEF and higher proportion of pulmonary hypertension than general and severe patients. Eighteen patients died during a median follow-up of 91 days. The multivariate Cox regression analysis revealed the acute cardiac injury, ARDS, RVFAC, RVFWLS, and 3D-RVEF were independent predictors of death. 3D-RVEF (chi-square to improve 18.3; <italic>P</italic> &lt; 0.001), RVFAC (chi-square to improve 4.5; <italic>P</italic> = 0.034) and 2D-RVFWLS (chi-square to improve 5.1; <italic>P</italic> = 0.024) all provided additional prognostic value of higher mortality over clinical risk factors. Moreover, the incremental predictive value of 3D-RVEF was significantly (<italic>P</italic> &lt; 0.05) higher than RVFAC and RVFWLS.</p><p><bold>Conclusion:</bold> 3D-RVEF was the most robust independent predictor of mortality in COVID-19 patients and provided a higher predictive value over conventional RV function parameters and RVFWLS, which may be helpful to identify COVID-19 patients at a higher risk of death.</p>