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Meta-Analysis
. 2021 Oct;44(10):1360-1370.
doi: 10.1002/clc.23719. Epub 2021 Sep 16.

Association between right ventricular dysfunction and mortality in COVID-19 patients: A systematic review and meta-analysis

Carlos Diaz-Arocutipa  1   2   3 , Jose Saucedo-Chinchay  4 , Edgar Argulian  5
Affiliations
Meta-Analysis

Association between right ventricular dysfunction and mortality in COVID-19 patients: A systematic review and meta-analysis

Carlos Diaz-Arocutipa et al. Clin Cardiol. 2021 Oct.

Abstract

There is limited evidence about the prognostic utility of right ventricular dysfunction (RVD) in patients with coronavirus disease 2019 (COVID-19). We assessed the association between RVD and mortality in COVID-19 patients. We searched electronic databases from inception to February 15, 2021. RVD was defined based on the following echocardiographic variables: tricuspid annular plane systolic excursion (TAPSE), tricuspid S' peak systolic velocity, fractional area change (FAC), and right ventricular free wall longitudinal strain (RVFWLS). All meta-analyses were performed using a random-effects model. Nineteen cohort studies involving 2307 patients were included. The mean age ranged from 59 to 72 years and 65% of patients were male. TAPSE (mean difference [MD], -3.13 mm; 95% confidence interval [CI], -4.08--2.19), tricuspid S' peak systolic velocity (MD, -0.88 cm/s; 95% CI, -1.68 to -0.08), FAC (MD, -3.47%; 95% CI, -6.21 to -0.72), and RVFWLS (MD, -5.83%; 95% CI, -7.47--4.20) were significantly lower in nonsurvivors compared to survivors. Each 1 mm decrease in TAPSE (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.08-1.37), 1% decrease in FAC (aHR, 1.09; 95% CI, 1.04-1.14), and 1% increase in RVFWLS (aHR, 1.33; 95% CI, 1.19-1.48) were independently associated with higher mortality. RVD was significantly associated with higher mortality using unadjusted risk ratio (2.05; 95% CI, 1.27-3.31), unadjusted hazard ratio (3.37; 95% CI, 1.72-6.62), and adjusted hazard ratio (aHR, 2.75; 95% CI, 1.52-4.96). Our study shows that echocardiographic parameters of RVD were associated with an increased risk of mortality in COVID-19 patients.

Keywords: coronavirus disease 2019; mortality; right ventricular dysfunction; systematic review.

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Conflict of interest statement

None of the authors reported any conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Forest plot showing the comparison of (A) Tricuspid annular plane systolic excursion (mm), (B) Tricuspid S′ peak systolic velocity (cm/s), (C) Fractional area change (%), and (D) Right ventricular free wall longitudinal strain (%) between survivors and nonsurvivors with COVID‐19. COVID‐19, coronavirus disease 2019
FIGURE 2
FIGURE 2
Forest plot showing the association between one unit change in (A) Tricuspid annular plane systolic excursion (mm), (B) Tricuspid S′ peak systolic velocity (cm/s), (C) Fractional area change (%), and (D) Right ventricular free wall longitudinal strain (%) and mortality in COVID‐19 patients (unadjusted estimates). CI, confidence interval; COVID‐19, coronavirus disease 2019; uHR, unadjusted hazard ratio
FIGURE 3
FIGURE 3
Forest plot showing the association between one unit change in (A) Tricuspid annular plane systolic excursion (mm), (B) Fractional area change (%), and (C) Right ventricular free wall longitudinal strain (%) and mortality in COVID‐19 patients (adjusted estimates). aHR, adjusted hazard ratio; CI, confidence interval; COVID‐19, coronavirus disease 2019
FIGURE 4
FIGURE 4
Forest plot showing the (A) RR, (B) uHR, and (C) aHR between right ventricular dysfunction and mortality in COVID‐19 patients. aHR, adjusted hazard ratio; CI, confidence interval; COVID‐19, coronavirus disease 2019; RR, risk ratio; uHR, unadjusted hazard ratio
See this image and copyright information in PMC

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