Abstract
AimTo investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute Respiratory Distress Syndrome (ARDS).MethodsNinety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratioResultsThe majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270 ± 104 vs. 117 ± 57 mmHg, p < 0.001). In the non-survivors, PASP was increased (42 ± 12 vs. 30 ± 7 mmHg, p < 0.001), while TAPSE was decreased (19 ± 4 vs. 25 ± 4 mm, p < 0.001). Accordingly, the TAPSE/PASP ratio was lower than in the survivors (0.51 ± 0.22 vs. 0.89 ± 0.29 mm/mmHg, p < 0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR: 0.026; 95%CI 0.01–0.579; p: 0.019) and PaO2/FIO2 (HR: 0.988; 95%CI 0.988–0.998; p: 0.018) ratios were the only independent predictors of mortality, with ROC-determined cutoff values of 159 mmHg and 0.635 mm/mmHg, respectively.ConclusionsCOVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19.
Highlights
Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2) infection, or Corona Virus Infectious Disease 2019 (COVID-19), may be complicated by the acute respiratory distress syndrome (ARDS) with reported high mortality rates between 26 and 61% [1, 2]
COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) adds to the prognostic relevance of P aO2/Fraction of inspired O2 (FIO2) in ARDS on COVID-19
Ninety-four patients were included in the study; they presented with fever (94/94, 100%), dyspnea (87/94, 93%), fatigue (94/94, 100%) and cough (58/94, 62%)
Summary
Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2) infection, or Corona Virus Infectious Disease 2019 (COVID-19), may be complicated by the acute respiratory distress syndrome (ARDS) with reported high mortality rates between 26 and 61% [1, 2]. We hypothesized that myocardial injury and inflammatory changes in COVID-19 could be an additional cause of ARDS-related acute right heart failure. We assessed the coupling of RV function to the pulmonary circulation in COVID-19 ARDS patients To this purpose, we used bedside transthoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio, previously shown to be a valid surrogate of the gold standard ratio of end-systolic to arterial elastance (Ees/ Ea) for the assessment of RV-arterial coupling [12] and an independent predictor of outcome in heart failure and pulmonary arterial hypertension [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
