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. 2021 Oct 1;49(10):1757-1768.
doi: 10.1097/CCM.0000000000005167.

Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome

Minesh Chotalia  1   2 , Muzzammil Ali  2 , Joseph E Alderman  1   2 , Manish Kalla  3 , Dhruv Parekh  1   2 , Mansoor N Bangash  1   2 , Jaimin M Patel  1   2
Affiliations

Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome

Minesh Chotalia et al. Crit Care Med. .

Abstract

Objectives: To assess whether right ventricular dilation or systolic impairment is associated with mortality and/or disease severity in invasively ventilated patients with coronavirus disease 2019 acute respiratory distress syndrome.

Design: Retrospective cohort study.

Setting: Single-center U.K. ICU.

Patients: Patients with coronavirus disease 2019 acute respiratory distress syndrome undergoing invasive mechanical ventilation that received a transthoracic echocardiogram between March and December 2020.

Intervention: None.

Measurements and main results: Right ventricular dilation was defined as right ventricular:left ventricular end-diastolic area greater than 0.6, right ventricular systolic impairment as fractional area change less than 35%, or tricuspid annular plane systolic excursion less than 17 mm. One hundred seventy-two patients were included, 59 years old (interquartile range, 49-67), with mostly moderate acute respiratory distress syndrome (n = 101; 59%). Ninety-day mortality was 41% (n = 70): 49% in patients with right ventricular dilation, 53% in right ventricular systolic impairment, and 72% in right ventricular dilation with systolic impairment. The right ventricular dilation with systolic impairment phenotype was independently associated with mortality (odds ratio, 3.11 [95% CI, 1.15-7.60]), but either disease state alone was not. Right ventricular fractional area change correlated with Pao2:Fio2 ratio, Paco2, chest radiograph opacification, and dynamic compliance, whereas right ventricular:left ventricle end-diastolic area correlated negatively with urine output.

Conclusions: Right ventricular systolic impairment correlated with pulmonary pathophysiology, whereas right ventricular dilation correlated with renal dysfunction. Right ventricular dilation with systolic impairment was the only right ventricular phenotype that was independently associated with mortality.

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Conflict of interest statement

Drs. Parekh and Patel received support for article research from Research Councils UK. Dr. Parekh received support for article research from the National Institute for Health Research. Dr. Bangash received funding from the Intensive Care Society. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart for the identification of patients included in the study. ARDS = acute respiratory distress syndrome, COVID-19 = coronavirus disease 2019, N = number, PCR = polymerase chain reaction, PPV = positive pressure ventilation, SARS-CoV-2 = severe acute respiratory syndrome coronavirus-2, TTE = transthoracic echocardiography, VV-ECMO = venovenous extracorporeal membrane oxygenation.
Figure 2.
Figure 2.
Kaplan-Meier curves of right ventricular (RV) phenotypes. Kaplan-Meier curves with log rank test. A, Patients with RV dilation. B, Patients with RV systolic impairment. C, Patients with RV dilation with normal systolic function, RV systolic impairment with normal size, and RV dilation with systolic impairment.
Figure 3.
Figure 3.
Odds ratio for 90-d mortality after multivariate logistic regression analysis. Numbers outline odds ratio with 95% CIs following multivariate logistic regression analysis. CXR = chest radiograph, P/F = Pao2:Fio2 ratio, PEEP = positive end-expiratory pressure, RRT = renal replacement therapy, RV = right ventricular.
See this image and copyright information in PMC

Comment in

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