Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes

Abstract

Background Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease. Results We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1. Conclusions In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.

Prognostic value of right ventricular dilatation on computed tomography pulmonary angiogram for predicting adverse clinical events in severe COVID-19 pneumonia

“…In the Suarez Castillejo et al ( 22 ) study, patients with COVID-19 and acute PE presented an elevated RV/LV ratio (mean at 1.0) without any association with ICU admission and mortality. In Tao et al ( 21 ) study, patients with adverse clinical events had a higher RV/LV ratio (1.06 ± 0.14 vs. 0.95 ± 0.15, p < 0.001). Moreover, the authors found that a cut-off value of 1.1 is a potential marker of adverse outcomes.…”

“…In the PE group ( n = 56/351, 16%), the mean RV/LV ratio was at 1.17 ( p = 0.011). In another study by Tao et al ( 21 ) CTPA was performed in 100 non-intubated COVID-19 patients without PE. The authors found a RV/LV ratio of 1.06 ± 0.14 in patients who developed adverse clinical events ( 21 ).…”

“…In another study by Tao et al ( 21 ) CTPA was performed in 100 non-intubated COVID-19 patients without PE. The authors found a RV/LV ratio of 1.06 ± 0.14 in patients who developed adverse clinical events ( 21 ). In our study, the mean RV/LV ratio was 0.91 [0.71–1.13], similar to that of the Suarez Castillejo et al ( 22 ) study, which reported in a cohort of 179 patients with CTPA a RV/LV ratio of 0.9 [0.9–1.0] with no difference between the PE group ( n = 76/179, 42%) and the non-PE group ( n = 105/179, 58%).…”