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Right ventricular dysfunction in critically ill COVID-19 ARDS.
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.
  • Bleakley C; Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK.
  • Singh S; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK.
  • Garfield B; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK.
  • Morosin M; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK.
  • Surkova E; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK.
  • Mandalia MS; Department of Medical Statistics, Imperial College, London, UK.
  • Dias B; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK.
  • Androulakis E; Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK.
  • Price LC; Pulmonary Hypertension Service, Royal Brompton Hospital, Sydney Street, London, UK.
  • McCabe C; Pulmonary Hypertension Service, Royal Brompton Hospital, Sydney Street, London, UK.
  • Wort SJ; Pulmonary Hypertension Service, Royal Brompton Hospital, Sydney Street, London, UK.
  • West C; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK.
  • Li W; Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK.
  • Khattar R; Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK.
  • Senior R; Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK.
  • Patel BV; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK.
  • Price S; Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK. Electronic address: s.price@rbht.nhs.uk.
Int J Cardiol ; 327: 251-258, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-938965
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / Ventricular Dysfunction, Right / COVID-19 Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Int J Cardiol Year: 2021 Document Type: Article Affiliation country: J.ijcard.2020.11.043

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / Ventricular Dysfunction, Right / COVID-19 Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Int J Cardiol Year: 2021 Document Type: Article Affiliation country: J.ijcard.2020.11.043