The Right Ventricle in COVID-19

Abstract

Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop various cardiac complications, among which dysfunction of the right ventricle (RV) appears particularly common, especially in severe forms of the disease, and which is associated with a dismal prognosis. Echocardiographic studies indeed reveal right ventricular dysfunction in up to 40% of patients, a proportion even greater when the RV is explored with strain imaging echocardiography. The pathophysiological mechanisms of RV dysfunction in COVID-19 include processes increasing the pulmonary vascular hydraulic load and others reducing RV contractility, which precipitate the acute uncoupling of the RV with the pulmonary circulation. Understanding these mechanisms provides the fundamental basis for the adequate therapeutic management of RV dysfunction, which incorporates protective mechanical ventilation, the prevention and treatment of pulmonary vasoconstriction and thrombotic complications, as well as the appropriate management of RV preload and contractility. This comprehensive review provides a detailed update of the evidence of RV dysfunction in COVID-19, its pathophysiological mechanisms, and its therapy.

The prognostic value of transthoracic echocardiography findings in hospitalized adult patients with COVID-19: A single-center retrospective analysis

“…The susceptibility of the overloaded right ventricle is further amplified by direct myocardial injury occurring from various mechanisms. 24 Besides RV dysfunction, WMAs were associated with both severity and mortality in our study. In a previous study, WMAs were observed in 15% of hospitalized adults with COVID-19, which is comparable to the prevalence in our cohort.…”

“…21,22 This hypercoagulable and hyperinflammatory state predisposes patients to pulmonary emboli and microthrombi, which are frequently observed in COVID-19. 23,24 Together, these factors increase pulmonary vascular resistance and right ventricular afterload, increasing the risk of RV dysfunction. The susceptibility of the overloaded right ventricle is further amplified by direct myocardial injury occurring from various mechanisms.…”

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

“…There is little data on RV diastolic dysfunction with which to compare the findings of the current study. The RV diastolic compliance is more pronounced than the LV, contributing to adaptations in preload 36 .…”

Mid-term subclinical myocardial injury detection in patients recovered from COVID-19 according pulmonary lesion severity

“…In COVID-19 patients, RV GLS alteration could be explained by RV inflammation and overload due to pulmonary embolism [23]. Several studies have reported that reduced RV GLS is associated with poor outcomes [8, 24]. In COVID-19 patients, RV free wall speckle tracking has a more excellent prognostic value than total RV strain (englobing inter-ventricular septum) which depends on LV systolic function and motion [7, 16, 25].…”