Clinical conditions and echocardiographic parameters associated with mortality in COVID-19

Angelo Silverio; Marco Di Maio; Fernando Scudiero; Vincenzo Russo; Luca Esposito; Emilio Attena; Salvatore Pezzullo; Guido Parodi; Antonello D'Andrea; Antonio Damato; Antonio Silvestro; Patrizia Iannece; Michele Bellino; Davide Di Vece; Anna Borrelli; Rodolfo Citro; Carmine Vecchione; Gennaro Galasso

doi:10.1111/eci.13638

Clinical conditions and echocardiographic parameters associated with mortality in COVID-19

Angelo Silverio, Marco Di Maio, Fernando Scudiero, Vincenzo Russo, Luca Esposito, Emilio Attena, Salvatore Pezzullo, Guido Parodi, Antonello D'Andrea, Antonio Damato, Antonio Silvestro, Patrizia Iannece, Michele Bellino, Davide Di Vece, Anna Borrelli, Rodolfo Citro, Carmine Vecchione, Gennaro Galasso

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Abstract

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19.

METHODS: This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses.

RESULTS: Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < .001), tricuspid annular plane systolic excursion (TAPSE, P < .001) and ARDS (P < .001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95-14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15-8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50-6.59).

CONCLUSIONS: TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.

Original language	English
Pages (from-to)	e13638
Journal	Eur. J. Clin. Invest.
Volume	51
Issue number	12
DOIs	https://doi.org/10.1111/eci.13638
Publication status	Published - Dec 2021

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Silverio, A., Di Maio, M., Scudiero, F., Russo, V., Esposito, L., Attena, E., Pezzullo, S., Parodi, G., D'Andrea, A., Damato, A., Silvestro, A., Iannece, P., Bellino, M., Di Vece, D., Borrelli, A., Citro, R., Vecchione, C., & Galasso, G. (2021). Clinical conditions and echocardiographic parameters associated with mortality in COVID-19. Eur. J. Clin. Invest., 51(12), e13638. https://doi.org/10.1111/eci.13638

Silverio, A, Di Maio, M, Scudiero, F, Russo, V, Esposito, L, Attena, E, Pezzullo, S, Parodi, G, D'Andrea, A, Damato, A, Silvestro, A, Iannece, P, Bellino, M, Di Vece, D, Borrelli, A, Citro, R, Vecchione, C & Galasso, G 2021, 'Clinical conditions and echocardiographic parameters associated with mortality in COVID-19', Eur. J. Clin. Invest., vol. 51, no. 12, pp. e13638. https://doi.org/10.1111/eci.13638

@article{159e01e2a24d4ad097fcc8a4c311d624,

title = "Clinical conditions and echocardiographic parameters associated with mortality in COVID-19",

abstract = "BACKGROUND: Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19.METHODS: This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses.RESULTS: Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < .001), tricuspid annular plane systolic excursion (TAPSE, P < .001) and ARDS (P < .001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95-14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15-8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50-6.59).CONCLUSIONS: TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.",

author = "Angelo Silverio and {Di Maio}, Marco and Fernando Scudiero and Vincenzo Russo and Luca Esposito and Emilio Attena and Salvatore Pezzullo and Guido Parodi and Antonello D'Andrea and Antonio Damato and Antonio Silvestro and Patrizia Iannece and Michele Bellino and {Di Vece}, Davide and Anna Borrelli and Rodolfo Citro and Carmine Vecchione and Gennaro Galasso",

note = "{\textcopyright} 2021 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.",

year = "2021",

month = dec,

doi = "10.1111/eci.13638",

language = "English",

volume = "51",

pages = "e13638",

journal = "Eur. J. Clin. Invest.",

issn = "0014-2972",

publisher = "John Wiley & Sons, Ltd",

number = "12",

}

TY - JOUR

T1 - Clinical conditions and echocardiographic parameters associated with mortality in COVID-19

AU - Silverio, Angelo

AU - Di Maio, Marco

AU - Scudiero, Fernando

AU - Russo, Vincenzo

AU - Esposito, Luca

AU - Attena, Emilio

AU - Pezzullo, Salvatore

AU - Parodi, Guido

AU - D'Andrea, Antonello

AU - Damato, Antonio

AU - Silvestro, Antonio

AU - Iannece, Patrizia

AU - Bellino, Michele

AU - Di Vece, Davide

AU - Borrelli, Anna

AU - Citro, Rodolfo

AU - Vecchione, Carmine

AU - Galasso, Gennaro

PY - 2021/12

Y1 - 2021/12

N2 - BACKGROUND: Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19.METHODS: This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses.RESULTS: Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < .001), tricuspid annular plane systolic excursion (TAPSE, P < .001) and ARDS (P < .001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95-14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15-8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50-6.59).CONCLUSIONS: TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.

AB - BACKGROUND: Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19.METHODS: This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses.RESULTS: Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < .001), tricuspid annular plane systolic excursion (TAPSE, P < .001) and ARDS (P < .001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95-14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15-8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50-6.59).CONCLUSIONS: TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.

U2 - 10.1111/eci.13638

DO - 10.1111/eci.13638

M3 - Article

C2 - 34287861

SN - 0014-2972

VL - 51

SP - e13638

JO - Eur. J. Clin. Invest.

JF - Eur. J. Clin. Invest.

IS - 12

ER -

Clinical conditions and echocardiographic parameters associated with mortality in COVID-19

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