Right ventricular dysfunction in critically ill COVID-19 ARDS. (15th March 2021)

• Record Type: Journal Article
• Authors: Bleakley, Caroline; Singh, Suveer; Garfield, Benjamin; Morosin, Marco; Surkova, Elena; Mandalia, Ms Sundhiya; Dias, Bernardo; Androulakis, Emmanouil; Price, Laura C.; McCabe, Colm; Wort, Stephen John; West, Cathy; Li, Wei; Khattar, Rajdeep; Senior, Roxy; Patel, Brijesh V.; Price, Susanna
• Is Part Of: International journal of cardiology. Volume 327(2021)
• Page Start: 251
• Page End: 258
• Publication Date: 2021-03-15
• Subjects: Echocardiography -- Critical care -- Acute respiratory distress syndrome -- COVID-19 -- Right ventricle; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.11.043
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Comprehensive echocardiography assessment of right ventricular (RV) impairment has not been reported in critically ill patients with COVID-19. We detail the specific phenotype and clinical associations of RV impairment in COVID-19 acute respiratory distress syndrome (ARDS). Methods: Transthoracic echocardiography (TTE) measures of RV function were collected in critically unwell patients for associations with clinical, ventilatory and laboratory data. Results: Ninety patients (25.6% female), mean age 52.0 ± 10.8 years, veno-venous extracorporeal membrane oxygenation (VVECMO) (42.2%) were studied. A significantly higher proportion of patients were identified as having RV dysfunction by RV fractional area change (FAC) (72.0%, 95% confidence interval (CI) 61.0–81.0) and RV velocity time integral (VTI) (86.4%, 95 CI 77.3–93.2) than by tricuspid annular plane systolic excursion (TAPSE) (23.8%, 95 CI 16.0–33.9), RVS' (11.9%, 95% CI 6.6–20.5) or RV free wall strain (FWS) (35.3%, 95% CI 23.6–49.0). RV VTI correlated strongly with RV FAC (p ≤ 0.01). Multivariate regression demonstrated independent associations of RV FAC with NTpro-BNP and PVR. RV-PA coupling correlated with PVR (univariate p < 0.01), as well as RVEDAi (p < 0.01), and RVESAi (p < 0.01), and was associated with P/F ratio (p 0.026), PEEP (p 0.025), and ALT (p 0.028). Conclusions: Severe COVID-19 ARDS is associated with a specific phenotype of RV radial impairment with sparing of longitudinal function. Clinicians should avoid interpretation of RV health purely on long-axis parameters in these patients. RV-PA coupling potentially provides important additional information above standard measures of RV performance in this cohort. Highlights: Critical COVID-19 patients in ICU are reliant on echocardiography to identify cardiac complications. There is a high incidence of RV radial dysfunction in this group. RV radial impairment correlates with markers of cardiac stress. Conventional echocardiographic measures of longitudinal function may miss the extent of RV impairment. RV-PA coupling provides additional information on RV performance in critically ill patients with COVID-19.