Persistent Right Ventricle Dilatation in SARS-CoV-2–Related Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation Support

Abstract

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Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients

“…This notion is confirmed by the observation when, despite preserved LV systolic function, there is a need for venovenous extracorporeal membrane oxygenation (ECMO) mortality in patients with RV dilatation is extremely high, 73% vs. 35% in patients with normal RV dimensions. 10 In our study, despite significantly milder than reported in the ECMO study disease severity, still there was a strong trend (p = 0.069) for RV dilatation in predicting mortality in the multivariate analysis along with positive pressure ventilation.…”

“…With the reported prevalence of RVD in COVID-19 patients ranging from 8% to 52%, 1 , 2 , 3 RVD is increasingly recognized as an important indicator of COVID-19 severity and adverse outcomes associated with severe COVID-19. 10 The exact mechanisms of RVD in COVID-19 remain under investigation and it continues to be unclear whether RVD is a marker of COVID-19 lung injury causing acute RV pressure overload or whether RVD is independent of the lung disease process. 4 It has been suggested that primary RVD may be due to direct myocardial injury from COVID-19 viral myocarditis, hypoxia, inflammatory response, and/or autoimmune injury.…”

The Clinical Role of Right Ventricle Changes in COVID-19 Respiratory Failure Depends on Disease Severity

“…One group was characterized by RV dysfunction: all these patients died because of unfavorable progression of COVID pulmonary disease characterized by bilateral pulmonary consolidations. The second group showed higher values of left ventricular ejection fraction and normal RV dimensions and function, but these patients died from septic shock [7] .…”

“…Serial echocardiography and an appreciation of the characteristic features of COVIDinduced respiratory failure may provide insights. As discussed by Dandel [2,6] and others [7,8], RV dilatation and dysfunction reflect and follow COVID-induced pulmonary thrombotic microangiopathy, a feature recognized as a characteristic pattern of COVID disease [9,10] . Thus, RV dilatation and dysfunction may be considered a marker of COVID disease severity, but may not fully explain why these changes are not directley related to mortality, especially in the critically ill patients [4,5].…”

“…The second group showed higher values of left ventricular ejection fraction and normal RV dimensions and function, but these patients died from septic shock. 7 …”