TY - JOUR

T1 - Myocardial Work in Patients Hospitalized With COVID-19

T2 - Relation to Biomarkers, COVID-19 Severity, and All-Cause Mortality

AU - Olsen, Flemming Javier

AU - Lassen, Mats Christian Højbjerg

AU - Skaarup, Kristoffer Grundtvig

AU - Christensen, Jacob

AU - Davidovski, Filip Soeskov

AU - Alhakak, Alia Saed

AU - Sengeløv, Morten

AU - Nielsen, Anne Bjerg

AU - Johansen, Niklas Dyrby

AU - Graff, Claus

AU - Bundgaard, Henning

AU - Hassager, Christian

AU - Jabbari, Reza

AU - Carlsen, Jørn

AU - Kirk, Ole

AU - Lindholm, Matias Greve

AU - Wiese, Lothar

AU - Kristiansen, Ole Peter

AU - Nielsen, Olav W.

AU - Lindegaard, Birgitte

AU - Tønder, Niels

AU - Ulrik, Charlotte Suppli

AU - Lamberts, Morten

AU - Sivapalan, Pradeesh

AU - Gislason, Gunnar

AU - Iversen, Kasper

AU - Jensen, Jens Ulrik Stæhr

AU - Schou, Morten

AU - Svendsen, Jesper Hastrup

AU - Smiseth, Otto Armin

AU - Remme, Espen Wattenberg

AU - Biering-Sørensen, Tor

N1 - Publisher Copyright: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is a.

PY - 2022

Y1 - 2022

N2 - BACKGROUND: COVID-19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVID-19. We hypothesized that GWI was associated with disease severity and all-cause death in patients with COVID-19. METHODS AND RESULTS: In a multicenter study of patients admitted with COVID-19 (n=305), 249 underwent pressure-strain loop analyses to quantify GWI at a median time of 4 days after admission. We examined the association of GWI to cardiac biomarkers (troponin and NT-proBNP [N-terminal pro-B-type natriuretic peptide]), disease severity (oxygen requirement and CRP [C-reactive protein]), and all-cause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707 mm Hg%; P=0.018). A curvilinear association to NT-proBNP was observed, with increasing NT-proBNP once GWI decreased below 1446 mm Hg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100– mm Hg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during follow-up (median, 58 days). In multivariable Cox regression, GWI was associated with all-cause death (hazard ratio, 1.08 [95% CI, 1.01–1.15], per 100– mm Hg% decrease), but did not increase C-statistics when added to clinical parameters. CONCLUSIONS: In patients admitted with COVID-19, our findings indicate that NT-proBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with all-cause death, but did not provide prognostic information beyond readily available clinical parameters. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04377035.

AB - BACKGROUND: COVID-19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVID-19. We hypothesized that GWI was associated with disease severity and all-cause death in patients with COVID-19. METHODS AND RESULTS: In a multicenter study of patients admitted with COVID-19 (n=305), 249 underwent pressure-strain loop analyses to quantify GWI at a median time of 4 days after admission. We examined the association of GWI to cardiac biomarkers (troponin and NT-proBNP [N-terminal pro-B-type natriuretic peptide]), disease severity (oxygen requirement and CRP [C-reactive protein]), and all-cause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707 mm Hg%; P=0.018). A curvilinear association to NT-proBNP was observed, with increasing NT-proBNP once GWI decreased below 1446 mm Hg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100– mm Hg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during follow-up (median, 58 days). In multivariable Cox regression, GWI was associated with all-cause death (hazard ratio, 1.08 [95% CI, 1.01–1.15], per 100– mm Hg% decrease), but did not increase C-statistics when added to clinical parameters. CONCLUSIONS: In patients admitted with COVID-19, our findings indicate that NT-proBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with all-cause death, but did not provide prognostic information beyond readily available clinical parameters. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04377035.

KW - corona

KW - COVID

KW - myocardial work

KW - pressure-strain

UR - http://www.scopus.com/inward/record.url?scp=85139403704&partnerID=8YFLogxK

U2 - 10.1161/JAHA.122.026571

DO - 10.1161/JAHA.122.026571

M3 - Journal article

C2 - 36129046

AN - SCOPUS:85139403704

VL - 11

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 19

M1 - e026571

ER -