Acute right ventricular failure in COVID-19 infection: A case series

García‐Cruz, Edgar; Manzur‐Sandoval, Daniel; Baeza-Herrera, Luis A.; Díaz-Méndez, Arturo; López-Zamora, Adán; González-Ruíz, Francisco J.; Ramos-Enríquez, Ángel; Melano-Carranza, Efrén; Rojas‐Velasco, Gustavo; Álvarez‐Álvarez, Rolando J.; Baranda-Továr, Francisco Martín

doi:10.1016/j.jccase.2021.01.001

Cited by 10 publications

(5 citation statements)

References 10 publications

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“…This high transpulmonary pressure can lead to alveolar overdistension that causes compression of the alveolar capillaries, resulting in an increased pulmonary vascular resistance, which contributes to the RV dysfunction. 8,9 García-Cruz et al reported an increased pulmonary artery systolic pressure (PASP) in up to 69.5% of patients. 4 Ventricular-arterial coupling involves the relationship between contractility and afterload, which can be evaluated with echocardiography by the tricuspid annular plane systolic excursion (TAPSE)/PASP ratio.…”

Section: Importancementioning

confidence: 99%

Right ventricular dysfunction and right ventricular–arterial uncoupling at admission increase the in‐hospital mortality in patients with COVID‐19 disease

et al. 2021

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Background: Coronavirus disease 2019 (COVID-19) frequently involves cardiovascular manifestations such as right ventricular (RV) dysfunction and alterations in pulmonary hemodynamics. We evaluated the application of the critical care ultrasonography ORACLE protocol to identify the most frequent alterations and their influence on adverse outcomes, especially those involving the RV (dilatation and dysfunction). Methods:This cross-sectional study included 204 adult patients with confirmed COVID-19 admitted at three centers. Echocardiography and lung ultrasound images were acquired on admission using the ORACLE ultrasonography algorithm.Results: Two-hundred and four consecutive patients were evaluated: 22 (11.9%) demonstrated a fractional shortening of < 35%; 33 (17.1%) a tricuspid annular plane systolic excursion (TAPSE) of < 17 mm; 26 (13.5%) a tricuspid peak systolic S wave tissue Doppler velocity of < 9.5 cm/sec; 69 (37.5%) a RV basal diameter of > 41 mm; 119 (58.3%) a pulmonary artery systolic pressure (PASP) of > 35 mm Hg; and 14 (11%) a TAPSE/PASP ratio of < .31. The in-hospital mortality rate was 37.6% (n = 71). Multiple logistic regression modeling showed that PASP > 35 mm Hg, RV FS of < 35%, TAPSE < 17 mm, RV S wave < 9.5, and TAPSE/PASP ratio < .31 mm/mm Hg were associated with this outcome. PASP and the TAPSE/PASP ratio had the lowest feasibility of being obtained among the investigators (62.2%). Conclusion:The presence of RV dysfunction, pulmonary hypertension, and alteration of the RV-arterial coupling conveys an increased risk of in-hospital mortality in patients presenting with COVID-19 upon admission; therefore, searching for these alterations should be routine. These parameters can be obtained quickly and safely with the ORACLE protocol.

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Section: Importancementioning

confidence: 99%

Right ventricular dysfunction and right ventricular–arterial uncoupling at admission increase the in‐hospital mortality in patients with COVID‐19 disease

et al. 2021

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“… 9 Our patient also had a severe TR, as seen in other cases of MIS-A. 1 , 5 , 8 , 10 Some of the most common aetiologies of functional TR are increased RV afterload, RV dilatation, and dysfunction, present in patients with SARS-CoV-2 infection and MIS-A as we just discussed. 11 …”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in adults with cardiac engagement: a case report and literature review

Massoud,

Westling,

Fischer

et al. 2023

European Heart Journal - Case Reports

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Background Following infection with severe acute respiratory syndrome coronavirus, a post-infectious multisystem inflammatory syndrome in adults (MIS-A) has been identified. It affects multiple organ systems and can lead to multi-organic failure. Case summary This case report describes a patient with MIS-A with significant cardiac involvement including peri-myocarditis, pulmonary hypertension, right-sided heart failure, tricuspid regurgitation, and cardiogenic shock. After being diagnosed and treated correctly for MIS-A, the patient recovered completely, without any cardiac sequelae. Discussion The hyperinflammation in MIS-A can have cardiac engagement. Although more research is required to further clarify the underlying mechanisms, prompt diagnosis and anti-inflammatory treatment are crucial for better outcomes and cardiac recovery.

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“…Transthoracic echocardiography is a useful tool for the timely diagnosis and early treatment of patients with this condition. It is currently well known that patients with RVD associated with ARDS have a worse prognosis [ 26 – 28 ]. In our study, no association of RVD between groups was found, contrary to what has been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Acute respiratory distress syndrome in patients with COVID-19 vs. Non-COVID-19: clinical characteristics and outcomes in a tertiary care setting in Mexico City

Palacios-Moguel,

Esquivel-Pineda,

Flores-Andrade

et al. 2023

BMC Pulm Med

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Background Acute Respiratory Distress Syndrome (ARDS) due tocoronavirus disease (COVID-19) infection has a unique phenotype generating a growing need to determine the existing differences that can alter existing evidence-based management strategies for ARDS. Research Question: What differences does the clinical profile of patients with ARDS due to COVID 19 and Non-COVID 19 have? Study Design and methods We conducted a comparative, observational, retrospective study in the Intensive Care Unit (ICU)of a third-level hospital in Mexico City, from March 2020 through March 2022. Clinical, echocardiographic, and laboratory variables were compared between patients with ARDS due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and those due to other etiologies. Results We enrolled 140 patients with a diagnosis of ARDS. The study group of COVID-19 etiology were younger males, higher body mass index, progressed to organ dysfunction, required more frequently renal replacement therapy, and higher SOFA score. There was no difference in rates of right ventricular dysfunction. Interpretation COVID-19 ARDS exhibit much greater severity that led to higher admission and mortality rates, whilst being younger and less comorbid.

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Acute right ventricular failure in COVID-19 infection: A case series

Cited by 10 publications

References 10 publications

Right ventricular dysfunction and right ventricular–arterial uncoupling at admission increase the in‐hospital mortality in patients with COVID‐19 disease

Right ventricular dysfunction and right ventricular–arterial uncoupling at admission increase the in‐hospital mortality in patients with COVID‐19 disease

Multisystem inflammatory syndrome in adults with cardiac engagement: a case report and literature review

Acute respiratory distress syndrome in patients with COVID-19 vs. Non-COVID-19: clinical characteristics and outcomes in a tertiary care setting in Mexico City

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