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Multicenter Study
. 2022 Mar 22;23(4):569-577.
doi: 10.1093/ehjci/jeab067.

Prognostic value of right ventricular dilatation in patients with COVID-19: a multicentre study

Laurie Soulat-Dufour  1 , Charles Fauvel  2 , Orianne Weizman  3   4 , Thomas Barbe  2 , Théo Pezel  5 , Delphine Mika  6 , Joffrey Cellier  7 , Laura Geneste  8 , Vassili Panagides  9 , Wassima Marsou  10 , Antoine Deney  11 , Sabir Attou  12 , Thomas Delmotte  13 , Sophie Ribeyrolles  14 , Pascale Chemaly  15 , Clement Karsenty  16 , Gauthier Giordano  3 , Alexandre Gautier  15 , Baptiste Duceau  4 , Willy Sutter  4 , Corentin Chaumont  2 , Pierre Guilleminot  17 , Audrey Sagnard  17 , Julie Pastier  16 , Antonin Trimaille  18 , Guillaume Bonnet  4   7 , Marjorie Canu  19 , Augustin Coisne  20 , Ariel Cohen  1
Affiliations
Multicenter Study

Prognostic value of right ventricular dilatation in patients with COVID-19: a multicentre study

Laurie Soulat-Dufour et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Although cardiac involvement has prognostic significance in coronavirus disease 2019 (COVID-19) and is associated with severe forms, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19.

Methods and results: Consecutive patients with COVID-19 admitted to 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Among 2878 patients, 445 (15%) underwent TTE. Most of these had cardiovascular risk factors, a history of cardiovascular disease, and were on cardiovascular treatments. Dilatation and dysfunction were observed in, respectively, 12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV). Primary composite outcome occurred in 44% (n = 196) of patients [9% (n = 42) for death without ICU transfer and 35% (n = 154) for admission to ICU]. RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex [hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.09 - 2.25; P = 0.02], higher body mass index (HR 1.10, 95% CI 1.02 - 1.18; P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 - 0.86; P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 - 2.64; P = 0.03) remained independently associated with the primary outcome.

Conclusion: Echocardiographic evaluation of RV dilatation could be useful for assessing risk of severe COVID-19 developing in hospitalized patients.

Keywords: COVID-19; echocardiography; prognosis; right ventricular.

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Figures

Figure 1
Figure 1
Flowchart and occurrence of primary outcome in patients with COVID-19. COVID-19, coronavirus disease-2019; ICU, intensive care unit; TTE, transthoracic echocardiography.
Figure 2
Figure 2
Kaplan–Meier curves showing event-free survival according to presence of RV dilatation in TTE. RV, right ventricular; TTE, transthoracic echocardiography.
Figure 3
Figure 3
Factors independently associated with the primary composite outcome in multivariable analysis. BMI, body mass index; CI, confidence interval; HR, hazard ratio; LV, left ventricular; RV, right ventricular.
Figure 4
Figure 4
Prognostic value of RV dilatation in patients with COVID-19. COVID-19, coronavirus disease-2019; ICU, intensive care unit; RV, right ventricular; SARS-Cov-2, severe acute respiratory syndrome coronavirus.
Figure 5
Figure 5
Illustration of the importance of the echocardiographic parameters in the natural history of patients hospitalized for COVID-19. CKD, chronic kidney disease; COVID-19, coronavirus disease-2019; HFpEF, heart failure with preserved ejection fraction; NT-pro-BNP, N-terminal-pro-B-type natriuretic peptide; RV, right ventricle; SARS-Cov-2, severe acute respiratory syndrome coronavirus; ULN, upper limit of normal.
See this image and copyright information in PMC

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