biostudies-literature00480Unknown8Zhang Y<b>Background:</b> RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in coronavirus disease 2019 (COVID-19) remains unknown. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients. <b>Methods:</b> A cohort of 128 COVID-19-confirmed patients who had undergone echocardiography were studied. Thirty-one healthy volunteers were also enrolled as controls. COVID-19 patients were divided into three subgroups (general, severe, and critical) according to COVID-19 severity-of-illness. Conventional RV structure and function parameters, RV free wall longitudinal strain (FWLS) and 3D-RVEF were acquired. RVFWLS was measured by two-dimensional speckle tracking echocardiography. RVEF was acquired by 3DE. <b>Results:</b> Compared with controls, 2D-RVFWLS and 3D-RVEF were both significantly decreased in COVID-19 patients (-27.2 ± 4.4% vs. -22.9 ± 4.8%, <i>P</i> < 0.001; 53.7 ± 4.5% vs. 48.5 ± 5.8%, <i>P</i> < 0.001). Critical patients were more likely to have a higher incidence of acute cardiac injury and acute respiratory distress syndrome (ARDS), and worse prognosis than general and severe patients. The critical patients exhibited larger right-heart chambers, worse RV fractional area change (RVFAC), 2D-RVFWLS, and 3D-RVEF and higher proportion of pulmonary hypertension than general and severe patients. Eighteen patients died during a median follow-up of 91 days. The multivariate Cox regression analysis revealed the acute cardiac injury, ARDS, RVFAC, RVFWLS, and 3D-RVEF were independent predictors of death. 3D-RVEF (chi-square to improve 18.3; <i>P</i> < 0.001), RVFAC (chi-square to improve 4.5; <i>P</i> = 0.034) and 2D-RVFWLS (chi-square to improve 5.1; <i>P</i> = 0.024) all provided additional prognostic value of higher mortality over clinical risk factors. Moreover, the incremental predictive value of 3D-RVEF was significantly (<i>P</i> < 0.05) higher than RVFAC and RVFWLS. <b>Conclusion:</b> 3D-RVEF was the most robust independent predictor of mortality in COVID-19 patients and provided a higher predictive value over conventional RV function parameters and RVFWLS, which may be helpful to identify COVID-19 patients at a higher risk of death.Frontiers in cardiovascular medicine641088https://www.ebi.ac.uk/biostudies/studies/S-EPMC7902006biostudies-literaturePrognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients.PMC7902006Xie YCui LWang BWu CXie MSun WHe LZhang LYuan HWang JLi MLi YYang YZhang YCai YLv Q48falsePrognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients.<b>Background:</b> RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in coronavirus disease 2019 (COVID-19) remains unknown. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients. <b>Methods:</b> A cohort of 128 COVID-19-confirmed patients who had undergone echocardiography were studied. Thirty-one healthy volunteers were also enrolled as controls. COVID-19 patients were divided into three subgroups (general, severe, and critical) according to COVID-19 severity-of-illness. Conventional RV structure and function parameters, RV free wall longitudinal strain (FWLS) and 3D-RVEF were acquired. RVFWLS was measured by two-dimensional speckle tracking echocardiography. RVEF was acquired by 3DE. <b>Results:</b> Compared with controls, 2D-RVFWLS and 3D-RVEF were both significantly decreased in COVID-19 patients (-27.2 ± 4.4% vs. -22.9 ± 4.8%, <i>P</i> < 0.001; 53.7 ± 4.5% vs. 48.5 ± 5.8%, <i>P</i> < 0.001). Critical patients were more likely to have a higher incidence of acute cardiac injury and acute respiratory distress syndrome (ARDS), and worse prognosis than general and severe patients. The critical patients exhibited larger right-heart chambers, worse RV fractional area change (RVFAC), 2D-RVFWLS, and 3D-RVEF and higher proportion of pulmonary hypertension than general and severe patients. Eighteen patients died during a median follow-up of 91 days. The multivariate Cox regression analysis revealed the acute cardiac injury, ARDS, RVFAC, RVFWLS, and 3D-RVEF were independent predictors of death. 3D-RVEF (chi-square to improve 18.3; <i>P</i> < 0.001), RVFAC (chi-square to improve 4.5; <i>P</i> = 0.034) and 2D-RVFWLS (chi-square to improve 5.1; <i>P</i> = 0.024) all provided additional prognostic value of higher mortality over clinical risk factors. Moreover, the incremental predictive value of 3D-RVEF was significantly (<i>P</i> < 0.05) higher than RVFAC and RVFWLS. <b>Conclusion:</b> 3D-RVEF was the most robust independent predictor of mortality in COVID-19 patients and provided a higher predictive value over conventional RV function parameters and RVFWLS, which may be helpful to identify COVID-19 patients at a higher risk of death.2021-01-01T00:00:00Z20212024-02-15T05:13:03.606Z2021-02-26T08:18:28ZS-EPMC79020063363417710.3389/fcvm.2021.641088