Predictive Value of Echocardiographic Pulmonary to Left Atrial Ratio for In-Hospital Death in Patients with COVID-19.
Giulia RendaMarco G MennuniGiovanni PizzoferratoDaniele EspostoAngela AlberaniSimona De VecchiAnna DegiovanniAilia GiubertoniEnrico Guido SpinoniLeonardo GrisafiEmanuele SagazioUcciferri ClaudioFalasca KatiaJacopo VecchietSabina GallinaGiuseppe PattiPublished in: Diagnostics (Basel, Switzerland) (2023)
Background: Echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) represents an accurate and sensitive non-invasive tool to estimate the trans-pulmonary gradient. The prognostic value of ePLAR in hospitalized patients with COVID-19 remains unknown. We aimed to investigate the predictive value of ePLAR on in-hospital mortality in patients with COVID-19. Methods: One hundred consecutive patients admitted to two Italian institutions for COVID-19 undergoing early (<24 h) echocardiographic examination were included; ePLAR was determined from the maximum tricuspid regurgitation continuous wave Doppler velocity (m/s) divided by the transmitral E-wave: septal mitral annular Doppler Tissue Imaging e′-wave ratio (TRVmax/E:e′). The primary outcome measure was in-hospital death. Results: patients who died during hospitalization had at baseline a higher prevalence of tricuspid regurgitation, higher ePLAR, right-side pressures, lower Tricuspid Annular Plane Systolic Excursion (TAPSE)/ systolic Pulmonary Artery Pressure (sPAP) ratio and reduced inferior vena cava collapse than survivors. Patients with ePLAR > 0.28 m/s at baseline showed non-significant but markedly increased in-hospital mortality compared to those having ePLAR ≤ 0.28 m/s (27% vs. 10.8%, p = 0.055). Multivariate Cox regression showed that an ePLAR > 0.28 m/s was independently associated with an increased risk of death (HR 5.07, 95% CI 1.04−24.50, p = 0.043), particularly when associated with increased sPAP (p for interaction = 0.043). Conclusions: A high ePLAR value at baseline predicts in-hospital death in patients with COVID-19, especially in those with elevated pulmonary arterial pressure. These results support an early ePLAR assessment in patients admitted for COVID-19 to identify those at higher risk and potentially guide strategies of diagnosis and care.
Keyphrases
- left atrial
- mitral valve
- pulmonary hypertension
- left ventricular
- pulmonary artery
- aortic stenosis
- aortic valve
- atrial fibrillation
- inferior vena cava
- healthcare
- coronavirus disease
- hypertrophic cardiomyopathy
- pulmonary arterial hypertension
- sars cov
- heart failure
- catheter ablation
- blood flow
- coronary artery
- blood pressure
- palliative care
- pulmonary embolism
- adverse drug
- risk factors
- acute care
- transcatheter aortic valve replacement
- ejection fraction
- vena cava
- photodynamic therapy
- coronary artery disease
- mass spectrometry