Right Ventricular Assessment in Critically Ill COVID-19 Patients and its Prognostic Importance

Yahia Mohamad; Rania El-Sherif; Mahmoud  Adel Gawish; Ibrahim Abdrabo; Hatem Hossam Mowafy

doi:10.3889/oamjms.2022.9172

Authors

Yahia Mohamad Critical Care Department, Benha Fever Hospital, Benha, Egypt https://orcid.org/0000-0002-6752-7312
Rania El-Sherif Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Mahmoud Adel Gawish Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0001-6047-621X
Ibrahim Abdrabo Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Hatem Hossam Mowafy Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.9172

Keywords:

Ventricular assessment, Critically ill, COVID, Cardiac injury

Abstract

Background; Cardiac injury is a prevalent complication and is associated with worse prognosis in COVID-19 patients. The increased cardiac workload resulting from respiratory failure and hypoxemia is a common mechanism of cardiac injury and the right ventricle may bear the brunt of its impact. The aim of the present study was to determine the incidence and prognostic value of RV dysfunction in COVID-19 patients admitted to ICU using conventional echocardiography parameters.Patients were subjected to full history taking, and clinical examination, Computed Tomography of chest was done for all patients to assess severity of lung infiltration, all patients received standard treatment according to Ministry of Health and Population COVID19 treatment protocol recommendations. Echocardiographic assessment was done to all patients.The mean age of the patients was 61.10±9.64years (range 42-80years).There were 36 (60%) male and 24 (40%) female. The non-survivor group consisted of 28 patients (46.7%) and survivors consisted of 32 patients (53.3%). There was statistically significant association between mortality and RV function regarding TAPSE, FAC%, RV basal diameter and EPAP. We concluded that in COVID-19 patients, RV function must be assessed and its prognostic importance recognized. RV dysfunction is not only a symptom of high pulmonary pressures, but it also contributes to cardiac insufficiency.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: What we know. Int J Infect Dis. 2020;94:44-8. https://doi.org/10.1016/j.ijid.2020.03.004 PMid:32171952 DOI: https://doi.org/10.1016/j.ijid.2020.03.004

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirusinfected pneumonia. N Engl J Med. 2020;382:1199-207. DOI: https://doi.org/10.1056/NEJMoa2001316

Perico L, Benigni A, Remuzzi G. Should COVID-19 concern nephrologists? Why and to what extent? The emerging impasse of angiotensin blockade. Nephron. 2020;144(5):213-21. https://doi.org/10.1159/000507305 PMid:32203970 DOI: https://doi.org/10.1159/000507305

Patel S, Rauf A, Khan H, Abu-Izneid T. Renin-angiotensinaldosterone (RAAS): The ubiquitous system for homeostasis and pathologies. Biomed Pharmacother. 2017;94:317-25. https://doi.org/10.1016/j.biopha.2017.07.091 PMid:28772209 DOI: https://doi.org/10.1016/j.biopha.2017.07.091

Lanza K, Perez LG, Costa LB, Cordeiro TM, Palmeira VA, Ribeiro VT, et al. Covid-19: The renin-angiotensin system imbalance hypothesis. Clin Sci. 2020;134(11):1259-64. https://doi.org/10.1042/CS20200492 PMid:32507883 DOI: https://doi.org/10.1042/CS20200492

Zhang Y, Sun W, Wu C, Zhang Y, Cui L, Xie Y, et al. Prognostic value of right ventricular ejection fraction assessed by 3D echocardiography in COVID-19 patients. Front Cardiovasc Med. 2021;8:61. https://doi.org/10.3389/fcvm.2021.641088 PMid:33634177 DOI: https://doi.org/10.3389/fcvm.2021.641088

Bleakley C, Singh S, Garfield B, Morosin M, Surkova E, Mandalia MS, et al. Right ventricular dysfunction in critically ill COVID-19 ARDS. Int J Cardiol. 2021;327:251-8. https://doi.org/10.1016/j.ijcard.2020.11.043 PMid:33242508 DOI: https://doi.org/10.1016/j.ijcard.2020.11.043

Akkaya F, Yenerçağ FN, Kaya A, Şener YZ, Bağcı A. Long term effects of mild severity COVID19 on right ventricular functions. Int J Cardiovasc Imaging. 2021;37(12):3451-7. https://doi.org/10.1007/s10554-021-02340-x PMid:34251551 DOI: https://doi.org/10.1007/s10554-021-02340-x

Ghidini S, Gasperetti A, Winterton D, Vicenzi M, Busana M, Pedrazzini G, et al. Echocardiographic assessment of the right ventricle in COVID-19: A systematic review. Int J Cardiovasc Imaging. 2021;37(12):3499-512. DOI: https://doi.org/10.1007/s10554-021-02353-6

Puntmann VO, Carerj ML, Wieters I. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(11):1265-73. https://doi.org/10.1001/jamacardio.2020.3557 PMid:32730619 DOI: https://doi.org/10.1001/jamacardio.2020.3557

Li YL, Zheng JB, Jin Y, Tang R, Li M, Xiu CH, et al. Acute right ventricular dysfunction in severe COVID-19 pneumonia. Rev Cardiovasc Med. 2020;21(4):635-41. https://doi.org/10.31083/j.rcm.2020.04.159 PMid:33388009 DOI: https://doi.org/10.31083/j.rcm.2020.04.159

Nekludova GV, Avdeev SN, Tsareva NA, Trushenko NV, Ataman K. Using TAPSE (tricuspid annular plane systolic excursion) as a predictor of poor prognosis of COVID-19: Is it enough? Int J Infect Dis. 2021;107:164. DOI: https://doi.org/10.1016/j.ijid.2021.04.056

Zuin M, Rigatelli G, Roncon L, Zuliani G. Relationship between echocardiographic tricuspid annular plane systolic excursion and mortality in COVID-19 patients: A meta-analysis. Echocardiography. 2021;38(9):1579-85. https://doi.org/10.1111/echo.15175 PMid:34355816 DOI: https://doi.org/10.1111/echo.15175

D’Alto M, Marra AM, Severino S, Salzano A, Romeo E, De Rosa R, et al. Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS. Crit Care. 2020;24(1):1-10. DOI: https://doi.org/10.1186/s13054-020-03385-5

Liaqat A, Ali-Khan RS, Asad M, Rafique Z. Evaluation of myocardial injury patterns and ST changes among critical and non-critical patients with coronavirus-19 disease. Sci Rep. 2021;11(1):1-8. DOI: https://doi.org/10.1038/s41598-021-84467-4

Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med. 2020;11:1-8. DOI: https://doi.org/10.1007/s42399-020-00363-4

Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of sex, age, and comorbidities with mortality in COVID-19 patients: A systematic review and metaanalysis. Intervirology. 2021;64(1):36-47. https://doi.org/10.1159/000512592 PMid:33296901 DOI: https://doi.org/10.1159/000512592

Zou X, Li S, Fang M, Hu M, Bian Y, Ling J, et al. Acute physiology and chronic health evaluation II score as a predictor of hospital mortality in patients of coronavirus disease 2019. Crit Care Med. 2020;48(8):e657. https://doi.org/10.1097/CCM.0000000000004411 PMid:32697506 DOI: https://doi.org/10.1097/CCM.0000000000004411

Selim S. Leukocyte count in COVID-19: An important consideration. Egypt J Bronchol. 2020;14(1):1-2. DOI: https://doi.org/10.1186/s43168-020-00045-8

Javanian M, Bayani M, Shokri M, Sadeghi-Haddad-Zavareh M, Babazadeh A, Yeganeh B, et al. Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: A retrospective cohort study. Rom J Intern Med. 2020;58(3):161-7. https://doi.org/10.2478/rjim-2020-0013 PMid:32396143 DOI: https://doi.org/10.2478/rjim-2020-0013

Su TH, Kao JH. The clinical manifestations and management of COVID-19-related liver injury. J Formos Med Assoc. 2020;119(6):1016. https://doi.org/10.1016/j.jfma.2020.04.020 PMid:32345544 DOI: https://doi.org/10.1016/j.jfma.2020.04.020

Khoonsari M, Zamani F, Niya MH, Hemmasi G, Ajdarkosh H, Faraji A, et al. Liver enzymes and inpatient deaths in COVID-19 hospitalized patients. Hepat Mon. 2020;20(11):e109076. DOI: https://doi.org/10.5812/hepatmon.109076

Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020;18(6):1469-72. https://doi.org/10.1111/jth.14848 PMid:32302435 DOI: https://doi.org/10.1111/jth.14848

Zhu Y, Zhang J, Li Y, Liu F, Zhou Q, Peng Z. Association between thrombocytopenia and 180-day prognosis of COVID-19 patients in intensive care units: A two-center observational study. PLoS One. 2021;16(3):e0248671. https://doi.org/10.1371/journal.pone.0248671 PMid:33735911 DOI: https://doi.org/10.1371/journal.pone.0248671

Li Y, Li F, Zhu S, Xie Y, Wang B, He L, et al. Prognostic value of right ventricular longitudinal strain in patients with COVID-19. JACC Cardiovasc Imaging. 2020;13(11):2287-99. https://doi.org/10.1016/j.jcmg.2020.04.014 PMid:32654963 DOI: https://doi.org/10.1016/j.jcmg.2020.04.014

Martha JW, Pranata R, Wibowo A, Lim MA. Tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography and mortality in COVID-19: A systematic review and meta-analysis. Int J Infect Dis. 2021;105:351-6. https://doi.org/10.1016/j.ijid.2021.02.029 PMid:33582370 DOI: https://doi.org/10.1016/j.ijid.2021.02.029

Diaz-Arocutipa C, Saucedo-Chinchay J, Argulian E. Association between right ventricular dysfunction and mortality in COVID-19 patients: A systematic review and meta-analysis. Clin Cardiol. 2021;44(10):1360-70. https://doi.org/10.1002/clc.23719 PMid:34528706 DOI: https://doi.org/10.1002/clc.23719