Predictive Value of Echocardiographic Pulmonary to Left Atrial Ratio for In-Hospital Death in Patients with COVID-19

• Published in: Diagnostics (Basel) Vol. 13; no. 2; p. 224
• Main Authors: Renda, Giulia, Mennuni, Marco G., Pizzoferrato, Giovanni, Esposto, Daniele, Alberani, Angela, De Vecchi, Simona, Degiovanni, Anna, Giubertoni, Ailia, Spinoni, Enrico Guido, Grisafi, Leonardo, Sagazio, Emanuele, Ucciferri, Claudio, Falasca, Katia, Vecchiet, Jacopo, Gallina, Sabina, Patti, Giuseppe
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 07.01.2023; MDPI
• Subjects: Cardiac arrhythmia; Coronaviruses; COVID-19; Ejection fraction; ePLAR; Heart attacks; Hospitalization; in-hospital mortality; Infections; Mortality; Pulmonary arteries; pulmonary embolism; Pulmonary embolisms; Pulmonary hypertension; Reproducibility; Severe acute respiratory syndrome coronavirus 2; Software; Thrombosis; trans-pulmonary pressure gradient; Velocity; Ventilators; Italy; COVID-19; in-hospital mortality; trans-pulmonary pressure gradient; pulmonary embolism; ePLAR
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics13020224

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.