A Comparative Study of the Right Heart Echocardiography Findings in COVID-19 and Non-COVID-19 Pneumonia in a South African Population

Abstract

Introduction The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD), portending a poorer prognosis than those without RVD. There is a paucity of data regarding right ventricular function in COVID-19 pneumonia from Africa and therefore in this comparative study of COVID-19 and non- COVID-19 pneumonia, we aimed to provide a detailed assessment of right heart function using conventional echocardiography and advanced strain imaging. Methods This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 community acquired pneumonia (CAP). Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Results We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 CAP. COVID-19 patients were significantly older, with a median age of 52 years (IQR 42-62.5, p=0.006), with fewer HIV positive patients, 25% versus 54% (p=0.01), and a higher frequency of hypertension and diabetes. There was a trend towards a lower severity of illness score (SAPS II). Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and RVS’ were not significantly different between COVID-19 and CAP . Mean RVFWS yielded the highest estimates for prevalence of RVD; 81% (CI 75-87%, n=43) amongst COVID-19 pneumonia patients and 79% (CI 71-87%, n=24) for CAP. Non-COVID patients with moderate to severe hypoxemia (PF<150) were at greater risk of an elevated RVSP >30mmHg RR= 3.25 (CI 1.35-7.82) on admission.Conclusion Despite a clinically significantly lower severity of illness score, patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID CAP. COVID-19 pneumonia patients had mortality that was significantly higher than predicted mortality. Additionally, despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, thus RVFWS served as an important marker of subclinical disease of RV.