Association of right ventricular dysfunction and pulmonary hypertension with adverse 30‐day outcomes in COVID‐19 patients

Abstract

Background: Cardiac manifestations in COVID-19 are multifactorial and are associated with increased mortality. The clinical utility and prognostic value of echocardiography in COVID-19 inpatients is not clearly defined. We aim to identify echocardiographic parameters that are associated with 30-day clinical outcomes secondary to COVID-19 hospitalization. Methods: This retrospective cohort study was conducted in a large tertiary hospital in New York City during the COVID-19 pandemic. It included 214 adult inpatients with a laboratory confirmed diagnosis of COVID-19 by reverse transcriptase polymerase chain reaction assay (RT-PCR) for SARS-CoV-2 on nasopharyngeal swab and had a transthoracic echocardiogram performed during the index hospitalization. Primary outcome was 30-day all-cause inpatient mortality. Secondary outcomes were 30-day utilization of mechanical ventilator support, vasopressors, or renal replacement therapy. Results: Mild right ventricular systolic dysfunction [OR:3.51, 95% CI:1.63–7.57, p=0.001], moderate to severe right ventricular systolic dysfunction [OR:7.30, 95% CI:2.20–24.25, p=0.001], pulmonary hypertension [OR:5.39, 95% CI:1.96–14.86, p=0.001], and moderate to severe tricuspid regurgitation [OR:3.92, 95% CI:1.71–9.03, p=0.001] were each associated with increased odds of 30-day all-cause inpatient mortality. Pulmonary hypertension and moderate to severe right ventricular dysfunction were each associated with increased odds of 30-day utilization of mechanical ventilator support and vasopressors. Conclusions: Right ventricular dysfunction, pulmonary hypertension, and moderate to severe tricuspid regurgitation were associated with increased odds for 30-day inpatient mortality. This study highlights the importance of echocardiography and its clinical utility and prognostic value for evaluating hospitalized COVID-19 patients.

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

“…A total of 350 studies were retrieved from the literature search (146 from MEDLINE and 204 from EMBASE). After the selection process, a total of 29 articles were included in the analysis 14 – 42 (Fig. S1 in Supplementary Materials).…”

“…Table 1 shows the baseline characteristics of the studies included in the meta-analysis. 29 studies reported data about the prevalence of RVD 14 – 42 , while 7 reported about all-cause mortality according to RVD status 17 , 19 , 20 , 30 , 33 , 35 , 36 . 11 studies were held in Europe 16 , 18 – 21 , 33 – 36 , 38 , 40 , 8 in North America 23 , 25 , 26 , 28 , 29 , 37 , 41 , 42 , 3 in Asia 30 – 32 , and 7 in other geographical locations 14 , 15 , 17 , 22 , 24 , 27 , 39 , including 2 multinational studies 24 , 27 .…”

Echocardiographic assessment of the right ventricle in COVID-19: a systematic review

“…Pulmonary hypertension (PH) is being increasingly reported among patients with COVID-19 [46,66,70,71]. Its development is likely multifactorial and may be related to ventilation perfusion mismatch in the setting of significant hypoxic respiratory failure and acute respiratory distress syndrome, increased pulmonary vascular tone in the setting of inflammatory state, and presence of microthrombi or pulmonary embolism in the lungs [13,27,71,72].…”

Recent advancements in pulmonary arterial hypertension and right heart failure research: overview of selected abstracts from ATS2020 and emerging COVID‐19 research

“…COVID-19 pandemic caused by the SARS-CoV-2 virus continues to inflict significant morbidity and mortality around the globe . Recent studies suggest potential pathologic interactions between SARS-CoV-2 infection, RV function, pulmonary vascular damages and PH [76][77][78][79][80][81] . Lungs of some patients dying with COVID-19 demonstrated pulmonary vascular involvement in the form of severe endothelial injury, cell death and thrombosis 77,78,80,82 .…”

“… 75 , 81 In fact, PH and RV dysfunction were associated with increased odds for 30-day inpatient mortality in COVID-19 patients. 79 It is postulated that increased RV afterload from acute respiratory distress syndrome and pulmonary thromboembolism, negative inotropic effects of cytokines, and direct angiotensin converting enzyme 2 (ACE2)-mediated cardiac injury from SARS-CoV-2 are potential mechanisms of RV dysfunction in COVID-19. 75 …”