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. 2021 Jan;3(1):91-100.
doi: 10.1016/j.cjco.2020.09.016. Epub 2020 Sep 20.

Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

William E Moody  1 , Hani M Mahmoud-Elsayed  1 , Jonathan Senior  1 , Uzma Gul  2 , Ayisha M Khan-Kheil  1 , Sebastian Horne  2 , Amitava Banerjee  3 , William M Bradlow  1 , Robert Huggett  2 , Sandeep S Hothi  4 , Muhammad Shahid  2 , Richard P Steeds  1
Affiliations

Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

William E Moody et al. CJC Open. 2021 Jan.

Erratum in

  • Errata.
    [No authors listed] [No authors listed] CJC Open. 2021 Feb;3(2):227. doi: 10.1016/j.cjco.2020.12.015. Epub 2020 Dec 23. CJC Open. 2021. PMID: 33521614 Free PMC article.

Abstract
in English, French

Background: Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia.

Methods: This was a multicentre, retrospective, observational study including 164 adults (aged 61 ± 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (interquartile range 2-5) from admission. The primary outcome was all-cause mortality.

Results: After a median follow-up of 31 days (interquartile range 14-42 days), 66 (40%) patients had died. The right ventricle was dilated in 62 (38%) patients, and 58 (35%) patients had right ventricular (RV) systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation, and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = -0.18, P = 0.025) and high-sensitivity cardiac Troponin (ρ = -0.30, P < 0.0001). Reduced RV systolic function (hazard ratio 1.80; 95% confidence interval, 1.05-3.09; P = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers, or mortality.

Conclusions: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is, however, no racial variation in the early findings on echocardiography, biomarkers, or mortality.

Contexte: Des études épidémiologiques suggèrent que les patients noirs, asiatiques et appartenant à des minorités ethniques (BAME) auraient un risque accru d'aggravation de la maladie à coronavirus 2019 (COVID-19), mais les facteurs physiopathologiques de cette association sont inconnus. Cette étude a cherché à étudier la relation entre les données d'échocardiographie, de mortalité, de l’origine ethnique avec la pneumonie associée à la COVID-19.

Méthodes: Il s'agit d'une étude observationnelle rétrospective multicentrique portant sur 164 adultes (âgés de 61 ± 13 ans; 78 % d'hommes; 36 % de BAME) hospitalisés pour la COVID-19 et soumis à une échocardiographie entre le 16 mars et le 9 mai 2020, trois jours (écart interquartile 2-5) après leur admission. Le critère principal d’évaluation était la mortalité, toutes causes confondues.

Résultats: Après un suivi médian de 31 jours (intervalle interquartile 14-42 jours), 66 (40 %) patients sont décédés. Le ventricule droit était dilaté chez 62 (38 %) des patients, et 58 (35 %) patients présentaient une dysfonction systolique du ventricule droit (VD). Seuls deux (1 %) patients présentaient une dilatation du ventricule gauche (VG), et 133 (81 %) avaient une fonction systolique VG normale ou en état hyperdynamique. Une réduction du déplacement systolique de l’anneau tricuspide a été associée à un taux de D-dimère élevé (ρ = -0,18, P = 0,025) et à une Troponine cardiaque de haute sensibilité (ρ = -0,30, P < 0,0001). Une fonction systolique VD réduite (rapport de risque de 1,80; intervalle de confiance à 95 %, 1,05-3,09 ; P = 0,032) était un facteur prédicteur indépendant pour la mortalité, toutes causes confondues, après ajustement pour les facteurs de risque démographiques et cliniques. En comparant les individus blancs et BAME, aucune différence n'a été constatée concernant les résultats d'échocardiographie, les biomarqueurs ou la mortalité.

Conclusions: Chez les patients hospitalisés pour une pneumonie liée à la COVID-19, une réduction de la fonction systolique VD est apparue comme prévalente et associée à la mortalité, toutes causes confondues. Il n'y a cependant aucune influence de l’ethnicité en rapport avec les premiers résultats d'échocardiographie, des biomarqueurs ou de la mortalité.

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Figures

Figure 1
Figure 1
Study CONSORT flow diagram. Of the original 2217 patients admitted with probable coronavirus disease 2019 (COVID-19), a total of 1582 patients subsequently tested positive for COVID-19 on nasopharyngeal throat swab polymerase chain reaction (PCR) testing. BSE, British Society of Echocardiography; echo, echocardiograph.
Figure 2
Figure 2
Kaplan-Meier curves for unadjusted cumulative survival from all-cause death among (A) all patients, (B) White patients, and (C) Black, Asian, and minority ethnic patients dichotomized according to right ventricular systolic function. Two-sided log rank tests were used to determine significance. FAC, fractional area change; TAPSE, tricuspid annular plane systolic excursion.
Figure 3
Figure 3
Kaplan-Meier curves for unadjusted cumulative survival from all-cause death among (A) all patients, (B) White patients, and (C) Black, Asian, and minority ethnic patients dichotomized according to tricuspid annular plane systolic excursion (TAPSE) <17 mm. Two-sided log rank tests were used to determine significance.
See this image and copyright information in PMC

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