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)".
Chiara LazzeriManuela BonizzoliStefano BatacchiGiovanni CianchiMarco ChiostriFilippo SocciAdriano PerisPublished in: Angiology (2022)
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.
Keyphrases
- acute respiratory distress syndrome
- mycobacterium tuberculosis
- extracorporeal membrane oxygenation
- mechanical ventilation
- coronavirus disease
- intensive care unit
- sars cov
- respiratory failure
- mitral valve
- pulmonary hypertension
- pulmonary artery
- emergency department
- oxidative stress
- early onset
- risk factors
- magnetic resonance
- cardiovascular disease
- randomized controlled trial
- heart failure
- left ventricular
- coronary artery
- study protocol
- drug induced
- magnetic resonance imaging
- congenital heart disease
- atrial fibrillation
- open label
- phase iii