Right Ventricular Hemodynamics in COVID Patients With Shock

ABSTRACT

Introduction: Patients with serious COVID infections frequently develop shock. Their right-sided hemodynamic profiles have not been well characterized. Method(s) In a prospectively collected database including 1997 patients hospitalized for COVID pneumonia from March 2020 to March 2021, 368 had shock requiring vasopressors. 327 had echocardiography to assess ventricular function and stroke volume based on clinical indications. LVEF (LV ejection fraction) and RVFAC (RV fractional area change) were measured using Simpson's rule, stroke volume (SV) by aortic Doppler, and RVSP (RV systolic pressure) from tricuspid regurgitation velocity;187 had evaluable data on all parameters. Patients were divided into groups with low or preserved RVFAC (RVFAC or RVFAC , cutoff <e35%), and low or normal cardiac index, (CI, CI or CI cutoff <e2.2 L/min/m2 ). Result(s) Mean age 65+/-12, LVEF 59.5+/-12.8, RVFAC 35.3+/-10.6, CI 2.41+/-0.89. Overall hospital mortality in this cohort with shock was 80%. Mean RVSP was 38.8+/-12.2, PEEP 11.0+/-3.7. 43% of patients had low RVFAC (<35%), and RVFAC correlated with other measures of RV function such as tricuspid annular peak systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S'). Higher RVSP correlated with lower CI (r=0.134, p= 0.016) but not with PEEP (r=0.03, p=0.70). Mortality did not differ significantly among groups, (p=0.19 by ANOVA) but was highest in the group with low RVFAC and low CI. (Figure) Conclusion(s) RV dysfunction is common in patients with severe COVID-19 and shock. Although RV dysfunction is probably associated with a worse prognosis, outcome in COVID may be tied to pulmonary recovery. Whether treatment targeted at RV dysfunction will improve outcome remains uncertain.