Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

Abstract

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The Right Ventricle in COVID-19 Lung Injury: Proposed Mechanisms, Management, and Research Gaps

“…As a result, RVD is associated with worse outcomes in the context of COVID-19 disease. 35 , 56 This remains very difficult to manage and future research should be directed at ways of protecting the RV before dysfunction develops, monitoring of RVD and response to treatment, echocardiographic and hemodynamic RVD phenotyping and effective management of established RV failure in patients with severe COVID-19 disease.…”

Tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography and mortality in COVID-19: A systematic review and meta-analysis

“…Widespread small pulmonary arteriolar fibrin thrombi and widespread alveolar capillary thrombi specific to COVID-19, compared with influenza cases, support the concept that RV dilatation is partly due to pressure overload. (Huang et al, 2020b;Moody et al, 2020;Stockenhuber et al, 2020) TAPSE was shown to be associated with the pulmonary embolism occurence in patients with COVID-19. (Scudiero et al, 2021) Myocardial injury and hyperinflammation in COVID-19-induced cytokine storm could be an additional cause of ARDS-related acute RHF.…”

“…HScTn is a powerful prognostic marker in COVID-19, with multiple potential causes, including myocarditis, coronary microvascular ischemia, stress cardiomyopathy, and tachycardiomyopathy. (Moody et al, 2020) Patients with proven myocardial damage are advised to undergo echocardiography as initial cardiac imaging, which appears to substantially alter clinical management in one-third of patients. (Stockenhuber et al, 2020) Likely echocardiography findings are: (1) swollen heart mostly due to pericardial effusion, characterized by excessive cardiac weight, thickened biventricular walls, and subsequent increase in biventricular mass; (2) hemodynamic disorder, reflected as reduced cardiac output and increased LV filling pressure; and (3) functional impairment, most commonly seen as RV systolic dysfunction rather than LV, with pulmonary hypertension and RV enlargement.…”

“…(D'Alto et al, 2020;Wibowo et al, 2021) Meanwhile, left ventricle (LV) function is usually relatively unaffected in the majority of COVID-19 patients. (Moody et al, 2020) Acute cor pulmonale or right heart failure (RHF) is a J o u r n a l P r e -p r o o f long-established complication of ARDS, in relation to disease severity and ventilatory strategies associated with permissive hypercapnia and pulmonary hyperinflation. (Yonas et al, 2020).…”

Role of advanced imaging in COVID-19 cardiovascular complications

“…In their echocardiographic study, Moody et al have found an independent association between reduced RV systolic dysfunction and all-cause mortality in severe COVID-19 patients with elevated TnT. Besides the effects of thromboembolic disease, authors hypothesized a possible primary RV involvement as a concurrent factor to RV injury [ 35 ]. In this clinical setting, a significant contribution could be provided by CMR, which has shown to be the gold standard for the evaluation of RV function together with tissue characterization [ 36 ].…”