Right heart function in patients with viral pneumonia of varying severity caused by SARS-n-COV-2

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Purpose the purpose of this study was to estimate condition of right heart in patients with COVID-19 and viral pneumonia. Material and methods 87 patients were included (age 53 ± 13, 58% male) with established diagnosis of COVID-19 via PСR and viral pneumonia on CT scans. Patient’s clinical condition was assessed by SHOCS-COVID and NEWS scales. Transthoracic echocardiography was performed on 12 ± 4.6 day from the first symptoms of disease. Levels of high-sense Troponin I and NT-proBNP were measured in blood samples. Results Patients were divided into 3 groups according to pattern of viral pneumonia severity on CT scans. Group I with CT 1 grade (involvement of the pulmonary parenchyma 0-25%) - 11(12.6%) patients; mid age- 48.9 ± 17 years; NEWS score – 1.4 ± 0.9; SHOCS-COVID score – 7.5 ± 3.7. Group II with CT 2 grade (involvement of the pulmonary parenchyma 25-50%). 48 (55.2%) patients; mid age- 51.6 ± 13.1 years; NEWS score - 2 ± 1; SHOCS-COVID score - 9 ± 2.1. Group III with CT 3 grade (involvement of the pulmonary parenchyma 50%-75%). 28 (32.2%) patients; mid age- 57.1 ± 10.3 years; NEWS score – 3.2 ± 1.5; SHOCS-COVID score – 12.4 ± 2. Groups didn’t differ in age (p-value >0.05). Highest NEWS and SHOCS-COVID scores were observed in group III (p < 0.0001 and p = 0.01, accordingly). All patients had preserved LV ejection fraction (62 ± 4.2%). Range of right heart echocardiography parameters was higher in patients with more severe grade of viral pneumonia: - pulmonary artery systolic pressure in group I – 26,3 ± 4 mmHg, in II ­– 28.7 ± 4 mmHg, in III – 29.1 ± 13.2 mmHg (pI-III= 0.002), r = 0.4, p < 0.0001; - myocardial systolic velocity (s’) of free tricuspid annulus site by TDI in group I–11 ± 0.5 cm/s, in II–13 ± 2 cm/s, in III –14 ± 2 cm/s (pI-III= 0.02), r = 0.4. p < 0.0001; - GLS of right ventricle (RV) in group I -18.6 ± 3%, in II – 21.6 ± 3.9%, in III – 21 ± 3.9% (pI-III = 0.038), r = 0.4, p = 0.005; - RV mid diameter in apical position in group I– 27 ± 2.8 mm, in II – 31 ± 5.1 mm, in III – 29 ± 4.2 mm (pI-III = 0.03), r = 0.3, p = 0.002. TAPSE and right heart areas didn’t differ between groups (p > 0.05). Levels of high-sense Troponin I were under 0.2 ng/ml in all groups (p > 0.05). NT-proBNP level were elevated only in group III – 172 [97,7;330] ng/l (pI-III = 0,03) and correlated with SHOCS-COVID scores (r = 0.4, p = 0.04), CT grade (r = 0.3, p = 0.01) and RV Tei index from pulse-wave Doppler (r = 0.3, p = 0.02). Conclusion perhaps, RV hyperfunction is compensatory reaction in response to increased afterload of right heart in patients with severe viral pneumonia caused by SARS-n-COV-2. Increased level of NT-proBNP indirectly confirms presence of myocardial stress in patients with severe viral pneumonia caused by SARS-n-COV-2.