Abstract
Aims: Pulmonary involvement in Coronavirus disease 2019 (COVID-19) may affect right ventricular (RV) function and pulmonary pressures. The prognostic value of tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PAPS), and TAPSE/PAPS ratios have been poorly investigated in this clinical setting. Methods and results: This is a multicenter Italian study, including consecutive patients hospitalized for COVID-19. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. The study included 227 (16.1%) subjects (mean age 68 ± 13 years); intensive care unit (ICU) admission was reported in 32.2%. At competing risk analysis, after stratifying the population into tertiles, according to TAPSE, PAPS, and TAPSE/PAPS ratio values, patients in the lower TAPSE and TAPSE/PAPS tertiles, as well as those in the higher PAPS tertiles, showed a significantly higher incidence of death vs. the probability to be discharged during the hospitalization. At univariable logistic regression analysis, TAPSE, PAPS, and TAPSE/PAPS were significantly associated with a higher risk of death and PE, both in patients who were and were not admitted to ICU. At adjusted multivariable regression analysis, TAPSE, PAPS, and TAPSE/PAPS resulted in independently associated risk of in-hospital death (TAPSE: OR 0.85, CI 0.74–0.97; PAPS: OR 1.08, CI 1.03–1.13; TAPSE/PAPS: OR 0.02, CI 0.02 × 10−1–0.2) and PE (TAPSE: OR 0.7, CI 0.6–0.82; PAPS: OR 1.1, CI 1.05–1.14; TAPSE/PAPS: OR 0.02 × 10−1, CI 0.01 × 10−2–0.04). Conclusions: Echocardiographic evidence of RV systolic dysfunction, increased PAPS, and poor RV-arterial coupling may help to identify COVID-19 patients at higher risk of mortality and PE during hospitalization.
Highlights
Coronavirus disease 2019 (COVID-19) sparked in Wuhan (China) and spread to other countries, rapidly reaching the dimensions of pandemic [1]
Given that COVID-19 involves the respiratory tract and may precipitate interstitial pneumonia, acute respiratory distress syndrome (ARDS), and pulmonary embolism (PE) [5], the effect on right ventricular (RV) function and pulmonary pressures are currently being investigated for the potential implications on patients treatment and outcome
All cases were confirmed by real-time, reverse transcriptase—polymerase chain reaction analysis of throat swab specimens, performed in all patients at admission independently by symptoms; COVID-19 diagnosis was based on the World Health Organization criteria
Summary
Coronavirus disease 2019 (COVID-19) sparked in Wuhan (China) and spread to other countries, rapidly reaching the dimensions of pandemic [1]. COVID-19 has been associated with cardiovascular complications, including myocardial injury, arrhythmias, acute coronary syndromes, myocarditis, pericarditis, and heart failure (HF) [2,3]. Given that COVID-19 involves the respiratory tract and may precipitate interstitial pneumonia, acute respiratory distress syndrome (ARDS), and pulmonary embolism (PE) [5], the effect on right ventricular (RV) function and pulmonary pressures are currently being investigated for the potential implications on patients treatment and outcome. Previous studies have shown that RV dysfunction [6] and pulmonary hypertension occur very frequently in patients with COVID-19, being reported in up to one-third of cases [7]. Few studies have investigated the effect of RV involvement and pulmonary hypertension in hospitalized patients with COVID-19. We aimed at evaluating routine echocardiographic assessment of RV function, pulmonary pressures, and RVarterial coupling, Ref. [9] as well as their association with the occurrence of death and PE in patients hospitalized with COVID-19
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