Prognostic value of right ventricular dilatation in patients with COVID-19: a multicentre study

Abstract

Aims Although cardiac involvement has prognostic significance in coronavirus disease 2019 (COVID-19) and is associated with severe forms, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19. Methods and results Consecutive patients with COVID-19 admitted to 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Among 2878 patients, 445 (15%) underwent TTE. Most of these had cardiovascular risk factors, a history of cardiovascular disease, and were on cardiovascular treatments. Dilatation and dysfunction were observed in, respectively, 12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV). Primary composite outcome occurred in 44% (n = 196) of patients [9% (n = 42) for death without ICU transfer and 35% (n = 154) for admission to ICU]. RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex [hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.09 − 2.25; P = 0.02], higher body mass index (HR 1.10, 95% CI 1.02 − 1.18; P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 − 0.86; P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 − 2.64; P = 0.03) remained independently associated with the primary outcome. Conclusion Echocardiographic evaluation of RV dilatation could be useful for assessing risk of severe COVID-19 developing in hospitalized patients.

Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

“…We found that ACP and age, but not LV dysfunction, are associated with mortality. In 2 studies performed in non-critically ill COVID-19 patients, RV dilatation was independently associated with death or subsequent ICU transfer [ 27 ] in one and echo parameters of LV and RV dysfunction were independently associated with poor prognosis in the other [ 28 ].…”

Right Ventricular Function in Acute Respiratory Distress Syndrome: Impact on Outcome, Respiratory Strategy and Use of Veno-Venous Extracorporeal Membrane Oxygenation

“…One preliminary study in a very small series of patients reported an incidence of 17% (Evrard et al, 2020). Other studies not only including critically ill patients reported an RV dilatation in 35% of cases (Dweck et al, 2020) or an impact of RV dilatation on ICU transfer or death (Soulat-Dufour et al, 2021). In 90 COVID-19 patients, Bleakley et al (2021) reported that radial RV dysfunction was common, while the longitudinal function was relatively spared.…”

TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy

“…It was also shown that one-third of patients hospitalized due to severe COVID-19 develop macrovascular thrombotic complications, including venous thromboembolism, stroke and myocardial injury/infarction [13]. Patients also suffer from right ventricular dilation of the heart [14][15][16]. Autopsies from COVID-19 patients also revealed multi-organ damage pattern consistent with microvascular injury [11,13].…”