# Reassessing the Prognostic Value of Point-of-Care Echocardiography in COVID-19 Patients: Right Heart, Wrong Signal?

## TL;DR

This study found that right ventricular strain detected via point-of-care ultrasound in COVID-19 patients without prior heart disease did not significantly predict worse outcomes or mortality.

## Contribution

The study evaluates the prognostic value of POCUS for right ventricular strain in a novel, non-cardiac patient cohort with COVID-19.

## Key findings

- RV strain was not significantly associated with adverse outcomes (p = 0.7).
- Mortality was lower in the RV strain group, but the difference was not statistically significant (p = 0.2).
- The study highlights the need for larger research to clarify the role of POCUS in predicting outcomes for these patients.

## Abstract

Background

Right ventricular (RV) strain detected via transthoracic echocardiography (TTE) has emerged as a potential prognostic marker in patients with COVID-19, given the virus’s cardiovascular implications. However, data on the prognostic utility of point-of-care ultrasound (POCUS) in this context remains limited. This study evaluated whether RV strain identified through limited POCUS TTE at emergency department (ED) presentation correlates with adverse clinical outcomes or mortality in SARS-CoV-2 positive patients without pre-existing cardiovascular disease.

Methods

This study followed 29 patients at a medical center in the United States, in a prospective cohort design. Participants included patients who tested positive for COVID-19 via polymerase chain reaction (PCR) and had no history of myocardial infarction, congestive heart failure, percutaneous coronary intervention, pulmonary embolism, or atrial fibrillation. Each underwent bedside POCUS TTE to assess for RV strain. Follow-up was conducted via structured phone surveys at 30, 60, and 90 days using a four-question instrument developed by the study team. The study was conducted from initial enrollment through the final 90-day follow-up period, with data collected between September 2020 and August 2021. We used chi-square tests to examine the relationship between echocardiographic findings and clinical outcomes.

Results

Among those with RV strain (D Sign positive), 60% experienced adverse outcomes, compared to 73.7% in those without RV strain. This difference was not statistically significant (p = 0.7). Mortality was also lower in the RV strain group (10%) compared to those without RV strain (31.6%), though this difference did not reach statistical significance (p = 0.2).

Conclusion

In this preliminary cohort, RV strain identified via limited POCUS TTE was not significantly associated with adverse outcomes or mortality in COVID-19 patients without prior cardiovascular disease. To better understand whether bedside echocardiography can predict clinical outcomes for this group, more extensive research is necessary.