Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality
Open accessAbstract
Background: Although troponin elevation is common in COVID-19, the extent of myocardial dysfunction and its contributors to dysfunction are less well-characterized. We aimed to determine the prevalence of subclinical myocardial dysfunction and its association with mortality using speckle tracking echocardiography (STE), specifically global longitudinal strain (GLS) and myocardial work efficiency (MWE). We also tested the hypothesis that reduced myocardial function was associated with increased systemic inflammation in COVID-19. Methods and Results: We conducted a retrospective study of hospitalized COVID-19 patients undergoing echocardiography (n = 136), of whom 83 and 75 had GLS (abnormal >−16%) and MWE (abnormal <95%) assessed, respectively. We performed adjusted logistic regression to examine associations of GLS and MWE with in-hospital mortality. Patients were mean 62 ± 14 years old (58% men). While 81% had normal left ventricular ejection fraction (LVEF), prevalence of myocardial dysfunction was high by STE; [39/83 (47%) had abnormal GLS; 59/75 (79%) had abnormal MWE]. Higher MWE was associated with lower in-hospital mortality in unadjusted [OR 0.92 (95% CI 0.85–0.99); p = 0.048] and adjusted models [aOR 0.87 (95% CI 0.78–0.97); p = 0.009]. In addition, increased systemic inflammation measured by interleukin-6 level was associated with reduced MWE. Conclusions: Subclinical myocardial dysfunction is common in COVID-19 patients with clinical echocardiograms, even in those with normal LVEF. Reduced MWE is associated with higher interleukin-6 levels and increased in-hospital mortality. Non-invasive STE represents a readily available method to rapidly evaluate myocardial dysfunction in COVID-19 patients and can play an important role in risk stratification.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In one study, cardiac dysfunction based on echocardiography-derived global longitudinal strain was found in ≈80% of COVID-19 cases that had elevated serum IL-6.
“In 1 study, cardiac dysfunction based on echocardiography-derived global longitudinal strain was found in ≈ 80% of COVID-19 cases that had elevated serum IL-6. 126”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [126]
The Clinical and Echocardiographic Characteristics section (page unavailable) reports higher IL-6 levels in patients with abnormal GLS, supporting an association. But it reports abnormal GLS in 39 of 83 patients (47%), not ≈80%; the Abstract (page unavailable) gives 79% for abnormal myocardial work efficiency, a different measure. The paper does not report ≈80% abnormal GLS among patients with elevated IL-6. (LLM, conf=0.88)
Experimental — accuracy not yet measuredmRNA vaccines have been found to produce symptoms associated with myocarditis within 3 to 11 days after the second vaccine dose and to produce a mixed infiltrate (macrophages and lymphocytes) in EMB, which is the typical time course of inflammation based on histology from viral and autoimmune myocarditis in patients and animal models.
“mRNA vaccines have been found to produce symptoms associated with myocarditis within 3 to 11 days after the second vaccine dose and to produce a mixed infiltrate (macrophages and lymphocytes) in EMB (Figure 2), which is the typical time course of inflammation based on histology from viral and autoimmune myocarditis in patients and animal models (eg, lymphocytic, giant cell myocarditis, and CVB3 my”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [126]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 54 · Cited by 34
Research works printed but not linked: 2
- Atri D, Siddiqi HK, Lang J, Nauffal V, Morrow DA, Bohula EA. COVID-19 for the cardiologist: a current review of the virology, clinical epidemiology, cardiac and other clinical manifestations and potential therapeutic strategies. JACC: Basic Transl Sci. (2020) 5:518-36. doi: 10.1016/j.jacbts.2020.04.002 · DOI
- The GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. (2017) 377:13-27. doi: 10.1056/NEJMoa1614362 · DOI · Paper page
- Authors
- Minhas, A. S., Gilotra, N. A., Goerlich, E., Metkus, T., Garibaldi, B. T., Sharma, G., Bavaro, N., Phillip, S., Michos, E. D., & Hays, A. G.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Hays, Allison G.
- ORCID
- Venue
- Frontiers in Cardiovascular Medicine
- Publisher
- Frontiers Media SA
- Published
- 2021-06-14
- Volume
- 8
- Pages
- 667721-667721
- ISSN
- 2297-055X (ISSN-L)
- PMC
- PMC8236710
- OpenAlex
- W3173072218
- Cited by
- 34
- References
- 54
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 10 · 2023: 9 · 2022: 10 · 2021: 1
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Cardiovascular Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Heart, Lung, and Blood Institute (R01HL147660, T32HL007024)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- COVID-19 pandemic, cardiac dysfunction, myocardial work efficiency, global longitudinal strain, speckle tracking echocardiography, in-hospital mortality, interleukin-6, systemic inflammation, subclinical cardiac dysfunction, left ventricular ejection fraction, risk stratification
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
