Parâmetros ecocardiográficos preditores de mortalidade intra-hospitalar em pacientes com COVID-19

Abstract

Background: Although the respiratory tract is the main target of the new coronavirus (SARS-CoV-2), disease of coronavirus (COVID-19) affects the cardiovascular system in a considerable number of cases, being one of the main determinants of hospital mortality. Many patients with COVID-19 have underlying cardiovascular disease or develop acute heart disease during the course of the disease. The main manifestations are arrhythmias, myocardial ischemia, myocarditis and shock. However, knowledge about the interaction between cardiovascular disease and COVID-19 is limited. One of the strategies to assess cardiovascular involvement in critically ill patients with COVID-19, with a high infectivity rate, was the use of portable equipment that allows for simplified bedside echocardiography protocols. Objectives: To identify echocardiographic parameters obtained by bedside echocardiography as predictors of in-hospital mortality in hospitalized patients with COVID-19. Methods: Patients admitted in two Reference Hospitals in Brazil between July to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE VividIQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were entered into multivariable models. Results: A total of 163 patients were enrolled, mean age was 64±16 years, 59% were men and 107 (66%) were admitted 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 variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age (OR=1.05, 95%CI 1.01–1.10, p=0.023), LVEF (OR=0.95, 95%CI 0.91–1.00, p=0.048) and TAPSE (OR=0.76, 95%CI 0.63– 0.91, p=0.005). The final model had good discrimination, with C-statistic of 0.78 (95%CI 0.68–0.88). Conclusion: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.