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- Title
Impact of acute TTE-evidenced cardiac dysfunction on in-hospital and outpatient mortality: A multicenter NYC COVID-19 registry study.
- Authors
Homan, Edwin A.; Devereux, Richard B.; Tak, Katherine A.; Mitlak, Hannah W.; Volodarskiy, Alexander; Ramasubbu, Kumudha; Zhang, David T.; Kushman, Arielle; Pollie, Meridith P.; Agoglia, Hannah K.; Tafreshi, Romina; Goyal, Parag; Shaw, Leslee; Ndhlovu, Lishomwa; RoyChoudhury, Arindam; Horn, Evelyn; Narula, Nupoor; Safford, Monika M.; Weinsaft, Jonathan W.; Kim, Jiwon
- Abstract
Background: COVID-19 is associated with cardiac dysfunction. This study tested the relative prognostic role of left (LV), right and bi- (BiV) ventricular dysfunction on mortality in a large multicenter cohort of patients during and after acute COVID-19 hospitalization. Methods/Results: All hospitalized COVID-19 patients who underwent clinically indicated transthoracic echocardiography within 30 days of admission at four NYC hospitals between March 2020 and January 2021 were studied. Images were re-analyzed by a central core lab blinded to clinical data. Nine hundred patients were studied (28% Hispanic, 16% African-American), and LV, RV and BiV dysfunction were observed in 50%, 38% and 17%, respectively. Within the overall cohort, 194 patients had TTEs prior to COVID-19 diagnosis, among whom LV, RV, BiV dysfunction prevalence increased following acute infection (p<0.001). Cardiac dysfunction was linked to biomarker-evidenced myocardial injury, with higher prevalence of troponin elevation in patients with LV (14%), RV (16%) and BiV (21%) dysfunction compared to those with normal BiV function (8%, all p<0.05). During in- and out-patient follow-up, 290 patients died (32%), among whom 230 died in the hospital and 60 post-discharge. Unadjusted mortality risk was greatest among patients with BiV (41%), followed by RV (39%) and LV dysfunction (37%), compared to patients without dysfunction (27%, all p<0.01). In multivariable analysis, any RV dysfunction, but not LV dysfunction, was independently associated with increased mortality risk (p<0.01). Conclusions: LV, RV and BiV function declines during acute COVID-19 infection with each contributing to increased in- and out-patient mortality risk. RV dysfunction independently increases mortality risk.
- Subjects
NEW York (N.Y.); HEART diseases; HOSPITAL mortality; COVID-19 pandemic; RIGHT ventricular dysfunction; MYOCARDIAL injury
- Publication
PLoS ONE, 2023, Vol 17, Issue 3, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0283708