Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

William E Moody,Hani M Mahmoud-Elsayed,Jonathan Senior,Uzma Gul,Ayisha M Khan-Kheil,Sebastian Horne,Amitava Banerjee,William M Bradlow,Robert Huggett,Sandeep S Hothi,Muhammad Shahid,Richard P Steeds

doi:10.1016/j.cjco.2020.09.016

Abstract

BackgroundEpidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia. MethodsThis was a multicentre, retrospective, observational study including 164 adults (aged 61 ± 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (interquartile range 2-5) from admission. The primary outcome was all-cause mortality. ResultsAfter a median follow-up of 31 days (interquartile range 14-42 days), 66 (40%) patients had died. The right ventricle was dilated in 62 (38%) patients, and 58 (35%) patients had right ventricular (RV) systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation, and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = −0.18, P = 0.025) and high-sensitivity cardiac Troponin (ρ = −0.30, P < 0.0001). Reduced RV systolic function (hazard ratio 1.80; 95% confidence interval, 1.05-3.09; P = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers, or mortality. ConclusionsIn patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is, however, no racial variation in the early findings on echocardiography, biomarkers, or mortality.

Highlights

Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown
Admission hemoglobin levels were lower and platelet count was higher in BAME compared with White patients, there were no significant differences between groups in neutrophil-to-lymphocyte ratio, D-dimer, high-sensitivity cardiac troponin (HScTn), or C-reactive protein (CRP) levels
This study has demonstrated the chief echocardiographic abnormalities in patients with severe COVID-19 pneumonia and elevated HScTn level, including right ventricular (RV) dilatation and impaired RV systolic function, whereas left ventricular (LV) function is usually preserved or hyperdynamic

Summary

Introduction

Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. Methods: This was a multicentre, retrospective, observational study including 164 adults (aged 61 Æ 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between. Cette etude a cherche à etudier la relation entre les donnees d’echocardiographie, de mortalite, de l’origine ethnique avec la pneumonie associee à la COVID-19. As the number of coronavirus disease 2019 (COVID-19) cases rises across the globe, there is evidence from epidemiologic studies that individuals of Black and minority ethnic (BAME) ancestry may be at higher risk of adverse outcomes.[1,2,3] In the United States, a report from the Centers for Disease Control and Prevention (CDC), compiled using

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