{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:21:34Z","timestamp":1766427694303,"version":"3.41.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:00:00Z","timestamp":1612828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> RVEF (right ventricular ejection fraction) measured by three-dimensional echocardiography (3DE) has been used in evaluating right ventricular (RV) function and can provide useful prognostic information in other various cardiovascular diseases. However, the prognostic value of 3D-RVEF in coronavirus disease 2019 (COVID-19) remains unknown. We aimed to investigate whether 3D-RVEF can predict the mortality of COVID-19 patients.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A cohort of 128 COVID-19-confirmed patients who had undergone echocardiography were studied. Thirty-one healthy volunteers were also enrolled as controls. COVID-19 patients were divided into three subgroups (general, severe, and critical) according to COVID-19 severity-of-illness. Conventional RV structure and function parameters, RV free wall longitudinal strain (FWLS) and 3D-RVEF were acquired. RVFWLS was measured by two-dimensional speckle tracking echocardiography. RVEF was acquired by 3DE.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Compared with controls, 2D-RVFWLS and 3D-RVEF were both significantly decreased in COVID-19 patients (\u221227.2 \u00b1 4.4% vs. \u221222.9 \u00b1 4.8%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001; 53.7 \u00b1 4.5% vs. 48.5 \u00b1 5.8%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). Critical patients were more likely to have a higher incidence of acute cardiac injury and acute respiratory distress syndrome (ARDS), and worse prognosis than general and severe patients. The critical patients exhibited larger right-heart chambers, worse RV fractional area change (RVFAC), 2D-RVFWLS, and 3D-RVEF and higher proportion of pulmonary hypertension than general and severe patients. Eighteen patients died during a median follow-up of 91 days. The multivariate Cox regression analysis revealed the acute cardiac injury, ARDS, RVFAC, RVFWLS, and 3D-RVEF were independent predictors of death. 3D-RVEF (chi-square to improve 18.3; <jats:italic>P<\/jats:italic> &amp;lt; 0.001), RVFAC (chi-square to improve 4.5; <jats:italic>P<\/jats:italic> = 0.034) and 2D-RVFWLS (chi-square to improve 5.1; <jats:italic>P<\/jats:italic> = 0.024) all provided additional prognostic value of higher mortality over clinical risk factors. Moreover, the incremental predictive value of 3D-RVEF was significantly (<jats:italic>P<\/jats:italic> &amp;lt; 0.05) higher than RVFAC and RVFWLS.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> 3D-RVEF was the most robust independent predictor of mortality in COVID-19 patients and provided a higher predictive value over conventional RV function parameters and RVFWLS, which may be helpful to identify COVID-19 patients at a higher risk of death.<\/jats:p>","DOI":"10.3389\/fcvm.2021.641088","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T07:40:35Z","timestamp":1612856435000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 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