ANA CLARA TUDE RODRIGUES
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
3 resultados
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- Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study(2022) KARAGODIN, Ilya; SINGULANE, Cristiane Carvalho; DESCAMPS, Tine; WOODWARD, Gary M.; XIE, Mingxing; TUCAY, Edwin S.; SARWAR, Rizwan; VASQUEZ-ORTIZ, Zuilma Y.; ALIZADEHASL, Azin; MONAGHAN, Mark J.; SALAZAR, Bayardo A. Ordonez; SOULAT-DUFOUR, Laurie; MOSTAFAVI, Atoosa; MOREO, Antonella; CITRO, Rodolfo; NARANG, Akhil; WU, Chun; ADDETIA, Karima; RODRIGUES, Ana C. Tude; LANG, Roberto M.; ASCH, Federico M.Background: COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection. Methods: Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyz-able, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardio-graphic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function. Results: For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not signif-icantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a signif-icant reduction of LVEF at follow-up (74.3% +/- 3.1% vs 64.4% +/- 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% +/- 5.9% vs 49.3% +/- 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<-18%) at baseline had a significant reduction of LVLS at follow-up (-21.6% +/- 2.6% vs-20.3% +/- 4.0%, P = .006), while patients with impaired LVLS at base-line had a significant improvement at follow-up (-14.5% +/- 2.9% vs-16.7% +/- 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>-20%) at baseline had significant improvement at follow-up (-15.2% +/- 3.4% vs -17.4% +/- 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 +/- 0.7 cm vs 4.6 +/- 0.6 cm, P = .019). Conclusions: Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.
- Human versus Artificial Intelligence-Based Echocardiographic Analysis as a Predictor of Outcomes: An Analysis from the World Alliance Societies of Echocardiography COVID Study(2022) ASCH, Federico M.; DESCAMPS, Tine; SARWAR, Rizwan; KARAGODIN, Ilya; SINGULANE, Cristiane Carvalho; XIE, Mingxing; TUCAY, Edwin S.; RODRIGUES, Ana C. Tude; VASQUEZ-ORTIZ, Zuilma Y.; MONAGHAN, Mark J.; SALAZAR, Bayardo A. Ordonez; SOULAT-DUFOUR, Laurie; ALIZADEHASL, Azin; MOSTAFAVI, Atoosa; MOREO, Antonella; CITRO, Rodolfo; NARANG, Akhil; WU, Chun; ADDETIA, Karima; UPTON, Ross; WOODWARD, Gary M.; LANG, Roberto M.Background: Transthoracic echocardiography is the leading cardiac imaging modality for patients admitted with COVID-19, a condition of high short-term mortality. The aim of this study was to test the hypothesis that artificial intelligence (AI)-based analysis of echocardiographic images could predict mortality more accu-rately than conventional analysis by a human expert. Methods: Patients admitted to 13 hospitals for acute COVID-19 who underwent transthoracic echocardiogra-phy were included. Left ventricular ejection fraction (LVEF) and left ventricular longitudinal strain (LVLS) were obtained manually by multiple expert readers and by automated AI software. The ability of the manual and AI analyses to predict all-cause mortality was compared. Results: In total, 870 patients were enrolled. The mortality rate was 27.4% after a mean follow-up period of 230 6 115 days. AI analysis had lower variability than manual analysis for both LVEF (P = .003) and LVLS (P = .005). AI-derived LVEF and LVLS were predictors of mortality in univariable and multivariable regression analysis (odds ratio, 0.974 [95% CI, 0.956-0.991; P = .003] for LVEF; odds ratio, 1.060 [95% CI, 1.019-1.105; P = .004] for LVLS), but LVEF and LVLS obtained by manual analysis were not. Direct comparison of the pre-dictive value of AI versus manual measurements of LVEF and LVLS showed that AI was significantly better (P = .005 and P = .003, respectively). In addition, AI-derived LVEF and LVLS had more significant and stronger correlations to other objective biomarkers of acute disease than manual reads. Conclusions: AI-based analysis of LVEF and LVLS had similar feasibility as manual analysis, minimized variability, and consequently increased the statistical power to predict mortality. AI-based, but not manual, analyses were a significant predictor of in-hospital and follow-up mortality. (J Am Soc Echocardiogr 2022;35:1226-37.)
- Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study(2021) KARAGODIN, Ilya; SINGULANE, Cristiane Carvalho; WOODWARD, Gary M.; XIE, Mingxing; TUCAY, Edwin S.; RODRIGUES, Ana C. Tude; VASQUEZ-ORTIZ, Zuilma Y.; ALIZADEHASL, Azin; MONAGHAN, Mark J.; SALAZAR, Bayardo A. Ordonez; SOULAT-DUFOUR, Laurie; MOSTAFAVI, Atoosa; MOREO, Antonella; CITRO, Rodolfo; NARANG, Akhil; WU, Chun; DESCAMPS, Tine; ADDETIA, Karima; LANG, Roberto M.; ASCH, Federico M.Background: The novel severe acute respiratory syndrome coronavirus-2 virus, which has led to the global coronavirus disease-2019 (COVID-19) pandemic is known to adversely affect the cardiovascular system through multiple mechanisms. In this international, multicenter study conducted by the World Alliance Societies of Echocardiography, we aim to determine the clinical and echocardiographic phenotype of acute cardiac disease in COVID-19 patients, to explore phenotypic differences in different geographic regions across the world, and to identify parameters associated with in-hospital mortality. Methods: We studied 870 patients with acute COVID-19 infection from 13 medical centers in four world regions (Asia, Europe, United States, Latin America) who had undergone transthoracic echocardiograms. Clinical and laboratory data were collected, including patient outcomes. Anonymized echocardiograms were analyzed with automated, machine learning-derived algorithms to calculate left ventricular (LV) volumes, ejection fraction, and LV longitudinal strain (LS). Right-sided echocardiographic parameters that were measured included right ventricular (RV) LS, RV free-wall strain (FWS), and RV basal diameter. Multivariate regression analysis was performed to identify clinical and echocardiographic parameters associated with in-hospital mortality. Results: Significant regional differences were noted in terms of patient comorbidities, severity of illness, clinical biomarkers, and LV and RV echocardiographic metrics. Overall in-hospital mortality was 21.6%. Parameters associated with mortality in a multivariate analysis were age (odds ratio [OR] = 1.12 [1.05, 1.22], P = .003), previous lung disease (OR = 7.32 [1.56, 42.2], P = .015), LVLS (OR = 1.18 [1.05, 1.36], P = .012), lactic dehydrogenase (OR = 6.17 [1.74, 28.7], P = .009), and RVFWS (OR = 1.14 [1.04, 1.26], P = .007). Conclusions: Left ventricular dysfunction is noted in approximately 20% and RV dysfunction in approximately 30% of patients with acute COVID-19 illness and portend a poor prognosis. Age at presentation, previous lung disease, lactic dehydrogenase, LVLS, and RVFWS were independently associated with in-hospital mortality. Regional differences in cardiac phenotype highlight the significant differences in patient acuity as well as echo cardiographic utilization in different parts of the world. (J Am Soc Echocardiogr 2021;34:819-30.)