Right ventricle early inflow-outflow index may inform about the severity of pneumonia in patients with COVID-19

Abstract

Background: Echocardiography is generally used in our daily practice to detect cardiovascular complications in COVID-19 patients and for etiological research in the case of worsened clinical status. Many echocardiographic parameters have been the subject of investigation in previous studies on COVID-19. Recently, the right ventricle early inflow-outflow (RVEIO) index has been identified as a possible and indirect marker of the severity of tricuspid regurgitation and right ventricular dysfunction in pulmonary embolism. In this study, we aimed to investigate the relationship between the severity of pneumonia in COVID-19 patients and the RVEIO index.

Methods: A total of 54 patients diagnosed with COVID-19 pneumonia were enrolled in this study. Our study population was separated into two groups as severe pneumonia and nonsevere pneumonia based on computed tomography imaging.

Results: Saturation O₂ , C-reactive protein, D-dimer, deceleration time, tricuspid annular plane systolic excursion, tricuspid lateral annular systolic velocity, and RVEIO index values were found to be significantly different between severe and nonsevere pneumonia groups. The result of the multivariate logistic regression test revealed that saturation O2, D-dimer, Sm, and RVEIO index were the independent predictive parameters for severe pneumonia. Receiver operating characteristic curve analysis demonstrated that RVEIO index >4.2 predicted severe pneumonia with 77% sensitivity and 79% specificity.

Conclusion: The RVEIO index can be used as a bedside, noninvasive, easily accessible, and useful marker to identify the COVID-19 patient group with widespread pneumonia and, therefore high risk of complications, morbidity, and mortality.

Keywords: COVID-19; RVEIO index; pneumonia; severity.

FIGURE 1

Measurement of right ventricle early inflow‐outflow (RVEIO) index parameters (tricuspid inflow early diastolic filling velocity = E velocity and right ventricular outflow tract velocity time integral [RVOT VTI])

FIGURE 2

Receiver operating characteristic curve analysis of the right ventricle early inflow‐outflow (RVEIO) index to predict the severe pneumonia (AUC: Area under the curve)