Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt


  • Mats Christian Højbjerg Lassen
  • Kristoffer Grundtvig Skaarup
  • Jannie Nørgaard Lind
  • Alia Saed Alhakak
  • Morten Sengeløv
  • Anne Bjerg Nielsen
  • Caroline Espersen
  • Kirstine Ravnkilde
  • Raphael Hauser
  • Liv Borum Schöps
  • Eva Holt
  • Niklas Dyrby Johansen
  • Daniel Modin
  • Kasper Djernæs
  • Claus Graff
  • Reza Jabbari
  • Uffe Bodtger
  • Matias Greve Lindholm
  • Gowsini Joseph
  • Lothar Wiese
  • Ole Peter Kristiansen
  • Emil Schwarz Walsted
  • Niels Tønder
  • Klaus Nielsen Jeschke
  • Pradeesh Sivapalan
  • Jacob Louis Marott
  • Gorm Jensen
  • Peter Schnohr
  • Peter Søgaard
  • Scott D. Solomon

Aims The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death.

Methods and results In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% +/- 4.3 vs. 18.5% +/- 3.0,P <0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 +/- 0.4 vs. 2.6 +/- 0.5,P <0.001), and RV strain (19.8 +/- 5.9 vs. 24.2 +/- 6.5,P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31],P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66],P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35],P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease.

Conclusions RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.

TidsskriftESC heart failure
Udgave nummer6
Sider (fra-til)4189-4197
StatusUdgivet - 2020

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