COVID-19 was confirmed by positive RT-PCR for SARS-CoV-2 from throat swabs, sputum or endotracheal suction. Presence of myocardial injury was defined by elevated hsTNT levels (Elecsys Troponin T hs by Roche Diagnostics GmbH, Vienna, Austria) above the 99th percentile upper reference limit (0.014 ng/ml). Acute respiratory distress syndrome (ARDS) was diagnosed according to the Berlin definition and Horovitz Index served for differentiation of severity as described before [5 (link)]. Pre-existing cardiovascular disease (CVD) comprised coronary artery disease, atrial fibrillation or known heart failure.
Systolic LV dysfunction (LVDsys) was indicated if 3D-LVEF was below 50% [9 (link), 10 (link)], or if LV global longitudinal strain (LV-GLS) was above -16% [11 (link)]. Diastolic LV dysfunction (LVDdia) was present if three out of the following six parameters were found: Mitral peak E velocity ≤ 50 cm/s, E/A ratio ≤ 0.8, average E/e′ > 14, septal e′ velocity < 7 cm/s or lateral e′ velocity < 10 cm/s, tricuspid regurgitation (TR) velocity > 280 cm/s or left atrial volume (3D-LAV) index > 34 ml/m2 [12 (link)]. Systolic right ventricular (RV) dysfunction (RVDsys) was defined as 3D-RVEF below 45% [13 (link)] or impaired RV free wall strain (RV-FWS) above -20% [9 (link)].
Systolic LV dysfunction (LVDsys) was indicated if 3D-LVEF was below 50% [9 (link), 10 (link)], or if LV global longitudinal strain (LV-GLS) was above -16% [11 (link)]. Diastolic LV dysfunction (LVDdia) was present if three out of the following six parameters were found: Mitral peak E velocity ≤ 50 cm/s, E/A ratio ≤ 0.8, average E/e′ > 14, septal e′ velocity < 7 cm/s or lateral e′ velocity < 10 cm/s, tricuspid regurgitation (TR) velocity > 280 cm/s or left atrial volume (3D-LAV) index > 34 ml/m2 [12 (link)]. Systolic right ventricular (RV) dysfunction (RVDsys) was defined as 3D-RVEF below 45% [13 (link)] or impaired RV free wall strain (RV-FWS) above -20% [9 (link)].
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