Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19

Abstract

ObjectiveTo assess the prevalence, characteristics and prognostic value of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in hospitalised, non-intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).MethodsThis single-centre, observational, cross-sectional study included 211 patients with COVID-19 admitted to non-ICU departments who underwent a single transthoracic echocardiography (TTE). Patients with poor acoustic window (n=11) were excluded. Clinical, imaging, laboratory and TTE findings were compared in patients with versus without PH (estimated systolic pulmonary artery pressure >35 mm Hg) and with versus without RVD (tricuspid annular plane systolic excursion <17 mm or S wave <9.5 cm/s). The primary endpoint was in-hospital death or ICU admission.ResultsA total of 200 patients were included in the final analysis (median age 62 (IQR 52–74) years, 65.5% men). The prevalence of PH and RVD was 12.0% (24/200) and 14.5% (29/200), respectively. Patients with PH were older and had a higher burden of pre-existing cardiac comorbidities and signs of more severe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (radiological lung involvement, laboratory findings and oxygenation status) compared with those without PH. Conversely, patients with RVD had a higher burden of pre-existing cardiac comorbidities but no evidence of more severe SARS-CoV-2 infection compared with those without RVD. The presence of PH was associated with a higher rate of in-hospital death or ICU admission (41.7 vs 8.5%, p<0.001), while the presence of RVD was not (17.2 vs 11.7%, p=0.404).ConclusionsAmong hospitalised non-ICU patients with COVID-19, PH (and not RVD) was associated with signs of more severe COVID-19 and with worse in-hospital clinical outcome.Trial registration numberNCT04318366

Integrated clinical role of echocardiography in patients with COVID-19

“…We are grateful to Dr Lazzeri et al 1 for their interest in our paper. 2 We agree entirely with their considerations about cardiovascular involvement and the role of echocardiographic assessment in patients with COVID-19. Since myocardial injury is frequently observed in hospitalised patients with COVID-19, only an integrated approach, weighting the relative contribution of factors associated with a primitive 'cardiac' injury and of those associated with a secondary involvement, may lead to appropriate diagnosis and treatment.…”

Right ventricular dysfunction in critically ill COVID-19 ARDS

“…Our data portrays a different picture of RV dysfunction from both non-COVID-19 ARDS and non-critical COVID-19 [ [22] , [23] , [24] ]. A recent large observational study reports important differences from our findings in a predominantly non-critical cohort [ 25 ].…”

Echocardiographic assessment of the right ventricle in COVID -related acute respiratory syndrome

“…In COVID-19-related ARDS, the development of increased systolic arterial pressures may be multi-factorial. First, hypoxic pulmonary vasoconstriction, known to characterize COVID-19-related ARDS [17], is probably the main factor. Second, lung disease (and progression) contributes to alterations in pulmonary circulation since atelectasia and consolidations exert mechanical compression of pulmonary vessels.…”