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WASE I: Echocardiography Predicts Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study.

  • | By Ultromics

Karagodin et al, J Am Soc Echocardiogr. 2021, Karagodin et al, ASE 2021. 

The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus which has led to the global Coronavirus disease-2019 (COVID-19) pandemic is known to adversely affect the cardiovascular system through both direct and indirect mechanisms.

In this international, multi-center study conducted by the World Alliance Societies of Echocardiography (WASE), we aim to determine the clinical and echocardiographic phenotype of acute cardiac disease in COVID-19 patients, using EchoGo Core, to explore phenotypic differences in different geographic regions across the world, and to identify which echocardiographic parameters are most predictive of early clinical outcomes.

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 (TTEs). Clinical and laboratory data were collected, including patient outcomes during their initial hospitalization. Anonymized echocardiograms were analysed with EchoGo Core to calculate left ventricular (LV) volumes, ejection fraction (EF), and LV global longitudinal strain (GLS). 

Significant regional differences were noted in terms of patient co-morbidities, severity of illness, clinical biomarkers, LV and RV echocardiographic metrics. Overall, 46.2% of the patients were in the intensive care unit, 27.1% were on a ventilator and in-hospital mortality was 22.2%. Predictors of mortality in a multivariate analysis were age (OR 1.12 [1.05, 1.22], p = 0.003), previous lung disease (OR 7.32 [1.56, 42.2], p = 0.015), LV GLS (OR 1.18 [1.05, 1.36], p = 0.012), LDH (OR 6.17 [1.74, 28.7], p = 0.009), and RV FWS (OR 1.14 [1.04, 1.26], p = 0.007).

LV and RV dysfunction are common manifestations of acute COVID-19 illness and portend a poor prognosis. Age at presentation, previous lung disease, lactic dehydrogenase (LDH) level, LVGLS, and RVFWS were independently associated with in-hospital mortality. Regional differences in patient phenotype highlight the significant differences in echocardiographic utilization and risk in these patients.


Left ventricular longitudinal strain (LV LS) was independently associated with mortality, while left ventricle ejection fraction (LVEF) was not. Fully automated quantification of LVEF and LVLS using AI minimized variability.

AI-based LV analyses, but not manual, were significant predictors of in-hospital and follow-up mortality.

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Why EchoGo Core? Manual interpretation of echocardiograms leads to inconsistency. Download this guide to learn how EchoGo Core is built to accurately automate key echocardiographic measurements with zero variability. Download.