Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome

Abstract

IntroductionRapid spread of COVID-19 has caused detrimental effect globally. Involvement of ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH) were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and its association with COVID-19 clinical outcome.Material and methodsA systematic data search was conducted through PubMed, MedRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using Revman v.5.4 and Stata v.16.ResultsA total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95%CI: 13%−25%), and PH was 22% (95% CI: 14%-31%). RVD was associated with increased mortality (OR=2.98 [95%CI: 1.50-5.89], p=0.002), severity (OR= 3.61 [95%CI: 2.05−6.35], p<0.001), ICU admission (OR= 1.70 [95%CI: 1.12−2.56], p=0.01), and mechanical ventilation (MV) usage (OR= 1.60 [95%CI: 1.14−2.25], p=0.007). PH was also associated with increased mortality (OR=5.42 [95%CI: 2.66-11.06], p<0.001), severity (OR=5.74 [95%CI: 2.28-14.49], p<0.001), and ICU admission (OR: 12.83 [95% CI: 3.55-46.41], p<0.001).ConclusionsRVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.

The Outcome of Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension during the COVID-19 Pandemic

“…14 In contrast with our study, a pooled analysis of some previous studies with a total of 294 COVID-19 patients with PAH demonstrated that PAH was significantly associated with an increased risk of mortality. 15 Furthermore, we observed a reduction in COVID-19 infection after vaccination. Despite the increase in infection rate during the fifth peak, the total PH group had lower infection rates.…”

“…14 In contrast with our study, a pooled analysis of some previous studies with a total of 294 COVID-19 patients with PAH demonstrated that PAH was significantly associated with an increased risk of mortality. 15…”

From acute SARS-CoV-2 infection to pulmonary hypertension

“…Most of the studies defined PH as pulmonary artery systolic pressure greater than 35–40 mmHg. The authors found that the prevalence of pulmonary hypertension and right ventricular dysfunction in COVID-19 was 22% and 19%, respectively and these were associated with increased hospital morbidity and mortality ( Oktaviono et al, 2021 ).…”

Efficacy of Sildenafil in Patients with Severe COVID-19 and Pulmonary Arterial Hypertension

“…Except for the direct causal factor, the pathomechanisms of COVID-19-induced pulmonary vasculopathy are similar to those in pulmonary arterial hypertension [ 3 ]. Most of the studies define PAH as systolic pulmonary artery pressure (sPAP) > 35–40 mm Hg [ 4 , 5 ]. The incidence of PAH varies depending on COVID-19 severity and is reported in 2% of patients with mild to moderate disease and nearly 50% of critical COVID-19 patients [ 6 , 7 ].…”

“…The incidence of PAH varies depending on COVID-19 severity and is reported in 2% of patients with mild to moderate disease and nearly 50% of critical COVID-19 patients [ 6 , 7 ]. A meta-analysis by Oktaviono et al [ 4 ] comprising 1728 COVID-19 patients from 16 studies demonstrated a PAH prevalence of 22% with a substantial impact on increased mortality (odds ratio, OR = 5.42), COVID-19 severity (OR = 5.74), and ICU admission (OR = 12.83), all p < 0.001. More recent studies present similar data [ 8 , 9 ].…”