Long-Term Prognostic Impact of Right Ventricular Dysfunction in Patients with COVID-19

Abstract

The characteristics and clinical course of hospitalized patients with coronavirus disease 2019 (COVID-19) have been widely described, while long-term data are still poor. The aim of this study was to evaluate the long-term clinical outcome and its association with right ventricular (RV) dysfunction in hospitalized patients with COVID-19. This was a prospective multicenter study of consecutive COVID-19 patients hospitalized at seven Italian Hospitals from 28 February to 20 April 2020. The study population was divided into two groups according to echocardiographic evidence of RV dysfunction. The primary study outcome was 1-year mortality. The propensity score matching was performed to balance for potential baseline confounders. The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); RV dysfunction was diagnosed in 63 cases (28%). Patients with RV dysfunction were older (75 vs. 67 years, p < 0.001), had higher prevenance of coronary artery disease (27% vs. 11%, p = 0.003), and lower left ventricular ejection fraction (50% vs. 55%, p < 0.001). The rate of 1-year mortality (67% vs. 28%; p ≤ 0.001) was significantly higher in patients with RV dysfunction compared with patients without. After propensity score matching, patients with RV dysfunction showed a worse long-term survival (62% vs. 29%, p < 0.001). The multivariable Cox regression model showed an independent association of RV dysfunction with 1-year mortality. RV dysfunction is a relatively common finding in hospitalized COVID-19 patients, and it is independently associated with an increased risk of 1-year mortality.

Early triage echocardiography to predict outcomes in patients admitted with COVID‐19: a multicenter study

“…Second, in contrast to previous studies, we analyzed data from patients screened immediately following admission, most of them likely before the onset of severe inflammation / cytokine storm and cardiac involvement, presumably limiting the accuracy of echo findings to predict outcomes. This may partially explain the differences between our observations and the existing literature, especially the lack of strong echocardiographic predictors 9,32 . Third, exams were acquired in a fixed time point (cross‐sectional analysis), and the longitudinal progression/regression of cardiac abnormalities during COVID‐19 was not assessed.…”

Role of cardiovascular magnetic resonance imaging in COVID‐19 recovered patients: A short‐term follow‐up study

“…RV dysfunction has an important bearing both on short as well long‐term outcomes. 25 , 26 Previous studies using CMR have reported RV dysfunction among COVID‐19 survivors 9 , 27 majority of which has been attributed to pulmonary fibrosis following lung injury and ARDS. Moderate and severe COVID‐19 infection has been associated with far greater RV dysfunction as compared to mild/asymptomatic cases.…”

“…In our study, COVID‐19 recovered patients had evidence of right ventricular (RV) dysfunction on CMR as compared to healthy controls. RV dysfunction has an important bearing both on short as well long‐term outcomes 25,26 . Previous studies using CMR have reported RV dysfunction among COVID‐19 survivors 9,27 majority of which has been attributed to pulmonary fibrosis following lung injury and ARDS.…”