Clinical Significance of Right Ventricle Echocardiographic Patterns in Critically-Ill COVID–Related Acute Respiratory Distress Syndrome "On Behalf of Protecting the Right Ventricle Network (PRORVnet)". (March 2023)

• Record Type: Journal Article
• Authors: Lazzeri, Chiara; Bonizzoli, Manuela; Batacchi, Stefano; Cianchi, Giovanni; Chiostri, Marco; Socci, Filippo; Peris, Adriano
• Is Part Of: Angiology. Volume 74:Number 3(2023)
• Page Start: 268
• Page End: 272
• Publication Date: 2023-03
• Subjects: right ventricle -- acute respiratory distress syndrome -- COVID -- pulmonary hypertension -- prognosis; Blood-vessels -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.13005
• DOI: 10.1177/00033197221105752
• Languages: English
• ISSNs: 0003-3197

Abstract

We assessed whether right ventricle (RV) alterations and their development may have clinical significance in critically-ill Coronavirus Disease (COVID) patients, as detected by serial echocardiograms during Intensive Care Unit (ICU) course. This observational single center study included 98 consecutive patients with COVID-related acute respiratory distress syndrome (ARDS). Three subgroups were considered: RV Dysfunction (Dys) on admission (10/98, 10%), developed RV Dys (17/98, 17%), and no RV Dys (71/98, 73%). Overall mortality at 3 months was 46.9%. The first subgroup was characterized by the highest need for Extracorporeal Membrane Oxygenation (ECMO) support ( P < .001) and a systemic inflammatory activation (as indicated by increased D-dimer), the second one by the lowest PaO2/FiO2 (P/F). At multivariate regression analysis, age and Sequential Organ Failure Assessment score were independent predictors for mortality. Different RV echo patterns were observed in critically ill patients presenting with COVID-related ARDS during ICU stay. RV Dys on admission was characterized by a high inflammatory activation while patients who developed RV Dys during ICU stay showed lowest P/F. Both these two subgroups identify patients with a severe COVID disease which in a high percentage of cases was unresponsive to standard treatment and required the use of ECMO.