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Gu H, Cirillo C, Nabeebaccus AA, Sun Z, Fang L, Xie Y, Demir O, Desai N, He L, Lü Q, Nakou E, O’Gallagher K, Tountas C, Marvaki A, Monaghan M, Perera D, Pericao A, Ryan M, Sinclair H, Stylianidis V, Victor K, Wang B, Wang J, Wang R, Wu C, Yang Y, Yuan H, Zhang D, Zhang Y, Faconti L, Papachristidis A, Zhang L, Carr-White G, Shah AM, Xie M, Chowienczyk P. First-Phase Ejection Fraction, a Measure of Preclinical Heart Failure, Is Strongly Associated With Increased Mortality in Patients With COVID-19. Hypertension 2021; 77:2014-2022. [PMID: 33966447 PMCID: PMC8115431 DOI: 10.1161/hypertensionaha.121.17099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Presence of heart failure is associated with a poor prognosis in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to examine whether first-phase ejection fraction (EF1), the ejection fraction measured in early systole up to the time of peak aortic velocity, a sensitive measure of preclinical heart failure, is associated with survival in patients hospitalized with COVID-19. A retrospective outcome study was performed in patients hospitalized with COVID-19 who underwent echocardiography (n=380) at the West Branch of the Union Hospital, Wuhan, China and in patients admitted to King's Health Partners in South London, United Kingdom. Association of EF1 with survival was performed using Cox proportional hazards regression. EF1 was compared in patients with COVID-19 and in historical controls with similar comorbidities (n=266) who had undergone echocardiography before the COVID-19 pandemic. In patients with COVID-19, EF1 was a strong predictor of survival in each patient group (Wuhan and London). In the combined group, EF1 was a stronger predictor of survival than other clinical, laboratory, and echocardiographic characteristics including age, comorbidities, and biochemical markers. A cutoff value of 25% for EF1 gave a hazard ratio of 5.23 ([95% CI, 2.85-9.60]; P<0.001) unadjusted and 4.83 ([95% CI, 2.35-9.95], P<0.001) when adjusted for demographics, comorbidities, hs-cTnI (high-sensitive cardiac troponin), and CRP (C-reactive protein). EF1 was similar in patients with and without COVID-19 (23.2±7.3 versus 22.0±7.6%, P=0.092, adjusted for prevalence of risk factors and comorbidities). Impaired EF1 is strongly associated with mortality in COVID-19 and probably reflects preexisting, preclinical heart failure.
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Affiliation(s)
- Haotian Gu
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
| | - Chiara Cirillo
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Adam A. Nabeebaccus
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Zhenxing Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Ozan Demir
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Nishita Desai
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Lin He
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Qing Lü
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Eleni Nakou
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Kevin O’Gallagher
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Christos Tountas
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Apostolia Marvaki
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Mark Monaghan
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Divaka Perera
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Ana Pericao
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Matthew Ryan
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Hannah Sinclair
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Vasileios Stylianidis
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Kelly Victor
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Bin Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Rui Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Hongliang Yuan
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Danqing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Yongxing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Luca Faconti
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Alexandros Papachristidis
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Gerald Carr-White
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Ajay M. Shah
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Phil Chowienczyk
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
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