The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

doi:10.1186/s13054-021-03591-9

Meta-Analysis

. 2021 May 21;25(1):172.

doi: 10.1186/s13054-021-03591-9.

The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

Ryota Sato¹, Siddharth Dugar^{2

3}, Wisit Cheungpasitporn⁴, Mary Schleicher⁵, Patrick Collier⁶, Saraschandra Vallabhajosyula^{7

8

9

10}, Abhijit Duggal^{1

11}

Affiliations

¹ Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
² Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. dugars@ccf.org.
³ Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA. dugars@ccf.org.
⁴ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁵ The Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
⁷ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁹ Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.
¹⁰ Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University of School of Medicine, Atlanta, GA, USA.
¹¹ Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA.

PMID: 34020703
PMCID: PMC8138512
DOI: 10.1186/s13054-021-03591-9

Meta-Analysis

The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

Ryota Sato et al. Crit Care. 2021.

. 2021 May 21;25(1):172.

doi: 10.1186/s13054-021-03591-9.

Authors

Ryota Sato¹, Siddharth Dugar^{2

3}, Wisit Cheungpasitporn⁴, Mary Schleicher⁵, Patrick Collier⁶, Saraschandra Vallabhajosyula^{7

8

9

10}, Abhijit Duggal^{1

11}

Affiliations

¹ Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
² Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. dugars@ccf.org.
³ Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA. dugars@ccf.org.
⁴ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁵ The Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
⁷ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁹ Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.
¹⁰ Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University of School of Medicine, Atlanta, GA, USA.
¹¹ Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA.

PMID: 34020703
PMCID: PMC8138512
DOI: 10.1186/s13054-021-03591-9

Abstract

Background: Previous studies have found various incidences of right ventricular (RV) injury and its association with clinical outcome in patients with acute respiratory distress syndrome (ARDS). In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RV injury on mortality in patients with ARDS.

Method: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RV injury and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients' and studies' characteristics and outcomes. RV injury was diagnosed by trans-thoracic echocardiogram (TTE), trans-esophageal echocardiogram (TEE) and PAC (pulmonary artery catheter) in the included studies. The primary outcome was the association between mortality and the presence of RV injury in patients with ARDS. The overall reported mortality was defined as either the intensive care unit (ICU) mortality, in-hospital mortality, or mortality within 90 days, and short-term mortality was defined as ICU-mortality, in-hospital mortality, or mortality within 30 days.

Results: We included 9 studies (N = 1861 patients) in this meta-analysis. RV injury that included RV dysfunction, RV dysfunction with hemodynamic compromise, RV failure, or acute cor-pulmonale was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RV injury in patients with ARDS was associated with significantly higher overall mortality (OR 1.45, 95% CI 1.13-1.86, p-value = 0.003, I² = 0%), as well as short-term mortality (OR 1.48, 95% CI 1.14-1.93, p-value = 0.003, I² = 0%).

Conclusion: In this systematic review and meta-analysis including 1861 patients with ARDS, the presence of RV injury was significantly associated with increased overall and short-term mortality.

Trial registration: The protocol was registered at PROSPERO (CRD42020206521).

Keywords: Acute cor pulmonale; Acute lung injury; Acute respiratory distress syndrome; Right ventricular dysfunction.

PubMed Disclaimer

Conflict of interest statement

We declare no competing interests.

Figures

**Fig. 1**
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) chart. Identification and selection of studies for inclusion

**Fig. 2**
Forest plot of patients with right ventricular injury versus those without: the pooled odds ratios of ICU-mortality, 28-day mortality, In-hospital mortality, 60-day mortality, and overall mortality

See this image and copyright information in PMC

Cited by

Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis.
Santos A, Monge-García MI, Borges JB, Retamal J, Tusman G, Larsson A, Suarez-Sipmann F. Santos A, et al. Intensive Care Med Exp. 2024 Apr 9;12(1):34. doi: 10.1186/s40635-024-00618-7. Intensive Care Med Exp. 2024. PMID: 38592650 Free PMC article.
Invasive mechanical ventilation.
Wong IMJ, Ferguson ND, Urner M. Wong IMJ, et al. Intensive Care Med. 2023 Jun;49(6):669-672. doi: 10.1007/s00134-023-07079-8. Epub 2023 Apr 28. Intensive Care Med. 2023. PMID: 37115258 No abstract available.
Diagnostic, prognostic and clinical value of left ventricular radial strain to identify paradoxical septal motion in ventilated patients with the acute respiratory distress syndrome: an observational prospective multicenter study.
Evrard B, Woillard JB, Legras A, Bouaoud M, Gourraud M, Humeau A, Goudelin M, Vignon P. Evrard B, et al. Crit Care. 2023 Nov 2;27(1):424. doi: 10.1186/s13054-023-04716-y. Crit Care. 2023. PMID: 37919787 Free PMC article.
Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study.
Huang S, Vieillard-Baron A, Evrard B, Prat G, Chew MS, Balik M, Clau-Terré F, De Backer D, Mekontso Dessap A, Orde S, Morelli A, Sanfilippo F, Charron C, Vignon P; ECHO-COVID study group. Huang S, et al. Intensive Care Med. 2023 Aug;49(8):946-956. doi: 10.1007/s00134-023-07147-z. Epub 2023 Jul 12. Intensive Care Med. 2023. PMID: 37436445
Perioperative management of the vulnerable and failing right ventricle.
Arora RC, Brown JK, Chatterjee S, Gan TJ, Singh G, Tong MZ; POQI IX Consortium. Arora RC, et al. Perioper Med (Lond). 2024 May 16;13(1):40. doi: 10.1186/s13741-024-00397-5. Perioper Med (Lond). 2024. PMID: 38750602 Free PMC article. Review.

See all "Cited by" articles

References

1. Zhang Z, Spieth PM, Chiumello D, Goyal H, Torres A, Laffey JG, Hong Y. Declining mortality in patients with acute respiratory distress syndrome: an analysis of the acute respiratory distress syndrome network trials. Crit Care Med. 2019;47(3):315–323. doi: 10.1097/CCM.0000000000003499. - DOI - PubMed
1. Zochios V, Parhar K, Tunnicliffe W, Roscoe A, Gao F. The right ventricle in ARDS. Chest. 2017;152(1):181–193. doi: 10.1016/j.chest.2017.02.019. - DOI - PubMed
1. Price LC, McAuley DF, Marino PS, Finney SJ, Griffiths MJ, Wort SJ. Pathophysiology of pulmonary hypertension in acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2012;302(9):L803–815. doi: 10.1152/ajplung.00355.2011. - DOI - PMC - PubMed
1. Mahmood SS, Pinsky MR. Heart-lung interactions during mechanical ventilation: the basics. Ann Transl Med. 2018;6(18):349–349. doi: 10.21037/atm.2018.04.29. - DOI - PMC - PubMed
1. Investigators TE, Coordinators ES. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness. The ESCAPE trial. JAMA. 2005;294(13):1625–1633. doi: 10.1001/jama.294.13.1625. - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- ClinicalTrials.gov

[1] Zhang Z, Spieth PM, Chiumello D, Goyal H, Torres A, Laffey JG, Hong Y. Declining mortality in patients with acute respiratory distress syndrome: an analysis of the acute respiratory distress syndrome network trials. Crit Care Med. 2019;47(3):315–323. doi: 10.1097/CCM.0000000000003499. - DOI - PubMed

[2] Zhang Z, Spieth PM, Chiumello D, Goyal H, Torres A, Laffey JG, Hong Y. Declining mortality in patients with acute respiratory distress syndrome: an analysis of the acute respiratory distress syndrome network trials. Crit Care Med. 2019;47(3):315–323. doi: 10.1097/CCM.0000000000003499. - DOI - PubMed

[3] Zochios V, Parhar K, Tunnicliffe W, Roscoe A, Gao F. The right ventricle in ARDS. Chest. 2017;152(1):181–193. doi: 10.1016/j.chest.2017.02.019. - DOI - PubMed

[4] Zochios V, Parhar K, Tunnicliffe W, Roscoe A, Gao F. The right ventricle in ARDS. Chest. 2017;152(1):181–193. doi: 10.1016/j.chest.2017.02.019. - DOI - PubMed

[5] Price LC, McAuley DF, Marino PS, Finney SJ, Griffiths MJ, Wort SJ. Pathophysiology of pulmonary hypertension in acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2012;302(9):L803–815. doi: 10.1152/ajplung.00355.2011. - DOI - PMC - PubMed

[6] Price LC, McAuley DF, Marino PS, Finney SJ, Griffiths MJ, Wort SJ. Pathophysiology of pulmonary hypertension in acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2012;302(9):L803–815. doi: 10.1152/ajplung.00355.2011. - DOI - PMC - PubMed

[7] Mahmood SS, Pinsky MR. Heart-lung interactions during mechanical ventilation: the basics. Ann Transl Med. 2018;6(18):349–349. doi: 10.21037/atm.2018.04.29. - DOI - PMC - PubMed

[8] Mahmood SS, Pinsky MR. Heart-lung interactions during mechanical ventilation: the basics. Ann Transl Med. 2018;6(18):349–349. doi: 10.21037/atm.2018.04.29. - DOI - PMC - PubMed

[9] Investigators TE, Coordinators ES. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness. The ESCAPE trial. JAMA. 2005;294(13):1625–1633. doi: 10.1001/jama.294.13.1625. - DOI - PubMed

[10] Investigators TE, Coordinators ES. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness. The ESCAPE trial. JAMA. 2005;294(13):1625–1633. doi: 10.1001/jama.294.13.1625. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

Affiliations

The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical