Skip to main content
SpringerLink
Log in

Predicting mortality in severe Covid-19 Pneumonia: the role of right ventricular dysfunction

  • Original Research
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Purpose

There is evidence that COVID-19 can have a clinically significant effect on the right ventricle (RV). Our objective was to enhance the efficiency of assessing RV dilation for diagnosing ACP by utilizing both linear measurements and qualitative assessment and its usefulness as an independent predictor of mortality.

Methods

This is an observational, retrospective and single-center study of the Intensive Care Unit of the Sanatorio de Los Arcos in Buenos Aires, Argentina from March 2020 to January 2022. All patients admitted with acute respiratory distress syndrome due to COVID-19 pneumonia (C-ARDS) on mechanical ventilation who were assessed by transthoracic echocardiography (TTE) were included.

Results

A total of 114 patients with C-ARDS requiring invasive mechanical ventilation were evaluated by echocardiography. 12.3% had RV dilation defined as a RV basal diameter greater than 41 mm, and 87.7% did not. Acute cor pulmonale (ACP) defined as RV dilation associated with paradoxical septal motion was found in 6.1% of patients. 7% had right ventricular systolic dysfunction according to qualitative evaluation. The different RV echocardiographic variables were studied with a logistic regression model as independent predictors of mortality. In the multivariate analysis, both the RV basal diameter and the presence of ACP showed to be independent predictors of in-hospital mortality with OR of 3.16 (95% CI 1.36–7.32) and 3.64 (95% CI 1.05–12.65) respectively.

Conclusion

An increase in the RV basal diameter and the presence of ACP measured by TTE are independent predictors of in-hospital mortality in patients with C-ARDS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. -D’Alto M, Marra AM, Severino S, Salzano A, Romeo E, De Rosa R, Stagnaro FM, Pagnano G, Verde R, Murino P, Farro A, Ciccarelli G, Vargas M, Fiorentino G, Servillo G, Gentile I, Corcione A, Cittadini A, Naeije R, Golino P. Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS. Crit Care. 2020;24(1):670. https://doi.org/10.1186/s13054-020-03385-5. PMID: 33256813; PMCID: PMC7703719.

    Article  PubMed  PubMed Central  Google Scholar 

  2. -Tavazzi G, Bergsland N, Alcada J, Price S. Early signs of right ventricular systolic and diastolic dysfunction in acute severe Respiratory Failure: the importance of diastolic restrictive pattern. Eur Heart J Acute Cardiovasc Care. 2020;9(6):649–56. Epub 2019 Nov 25. PMID: 31762290; PMCID: PMC7206565.

    Article  PubMed  Google Scholar 

  3. Taha A, Zaytoun T, Eid H, Baess A, Elreweny E. Echocardiographic assessment of the right ventricle and its correlation with patient outcome in acute respiratory distress syndrome. Adv Respir Med. 2020;88(5):412–9. https://doi.org/10.5603/ARM.a2020.0153. PMID: 33169813.

    Article  PubMed  Google Scholar 

  4. -Chotalia M, Ali M, Alderman JE, Kalla M, Parekh D, Bangash MN, Patel JM. Right ventricular dysfunction and its Association with Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome. Crit Care Med. 2021;49(10):1757–68. PMID: 34224453; PMCID: PMC8439642.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. -Manzur-Sandoval D, García-Cruz E, Gopar-Nieto R, Arteaga-Cárdenas G, Rascón-Sabido R, Mendoza-Copa G, Lazcano-Díaz E, Barajas-Campos RL, Jordán-Ríos A, Rodríguez-Jiménez GM, Martínez DS, Murillo-Ochoa AL, Díaz-Méndez A, Bucio-Reta E, Rojas-Velasco G, Baranda-Tovar F. Right ventricular dysfunction and right ventricular-arterial uncoupling at admission increase the in-hospital mortality in patients with COVID-19 Disease. Echocardiography. 2021;38(8):1345–51. https://doi.org/10.1111/echo.15164. Epub 2021 Jul 19. PMID: 34286870; PMCID: PMC8444818.

    Article  PubMed  PubMed Central  Google Scholar 

  6. -Ghidini S, Gasperetti A, Winterton D, Vicenzi M, Busana M, Pedrazzini G, Biasco L, Tersalvi G. Echocardiographic assessment of the right ventricle in COVID-19: a systematic review. Int J Cardiovasc Imaging. 2021;37(12):3499–512. https://doi.org/10.1007/s10554-021-02353-6. Epub 2021 Jul 22. PMID: 34292433; PMCID: PMC8295549.

    Article  PubMed  PubMed Central  Google Scholar 

  7. -Ortiz F, Brunsvold ME, Bartos JA. Right ventricular dysfunction and mortality after cannulation for venovenous extracorporeal membrane oxygenation. Crit Care Explor. 2020;2(11):e0268. https://doi.org/10.1097/CCE.0000000000000268. PMID: 33196050; PMCID: PMC7655090.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Force DT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33. https://doi.org/10.1001/jama.2012.5669. PMID: 22797452.

  9. -Gomez JMD, Zimmerman AC, du Fay de Lavallaz J, Wagner J, Tung L, Bouroukas A, Nguyen TTP, Canzolino J, Goldberg A, Santos Volgman A, Suboc T, Rao AK. Echocardiographic predictors of mortality and morbidity in COVID-19 Disease using focused cardiovascular ultrasound. Int J Cardiol Heart Vasc. 2022;39:100982. Epub 2022 Feb 25. PMID: 35233442; PMCID: PMC8872842.

    PubMed  PubMed Central  Google Scholar 

  10. -Cheong I, Otero Castro V, Gómez RA, Merlo PM, Tamagnone FM. Transthoracic echocardiography of patients in prone position ventilation during the COVID-19 pandemic: an observational and retrospective study. Int J Cardiovasc Imaging. 2022 Jun 26:1–7. https://doi.org/10.1007/s10554-022-02659-z. Epub ahead of print. PMCID: PMC9244514.

  11. -Mekontso Dessap A, Boissier F, Charron C, Bégot E, Repessé X, Legras A, Brun-Buisson C, Vignon P, Vieillard-Baron A. Acute Cor Pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive Care Med. 2016;42(5):862–70. Epub 2015 Dec 9. PMID: 26650055.

    Article  PubMed  Google Scholar 

  12. -Belligund P, Lee D, Balasubramaniam M, Khanijao S, Damania D, Vallumsetla N, Sajawal Q, Perez-Gandara B, Perez-Perez J, Shalom I, Dubey G, Sanghavi S, Lu C, Mitre C, Zein J, Al-Ajam M. Right ventricle dilation detected on point-of-care ultrasound is a predictor of poor outcomes in critically Ill patients with COVID-19. Fed Pract. 2021;38(9):396–401. https://doi.org/10.12788/fp.0177. Epub 2021 Sep 12. PMID: 34737535; PMCID: PMC8562899.

    Article  PubMed  PubMed Central  Google Scholar 

  13. -Kirkpatrick JN, Mitchell C, Taub C, Kort S, Hung J, Swaminathan M. ASE Statement on Protection of patients and Echocardiography Service Providers during the 2019 Novel Coronavirus Outbreak: endorsed by the American College of Cardiology. J Am Soc Echocardiogr. 2020;33(6):648–53. Epub 2020 Apr 3. PMID: 32503700; PMCID: PMC7129086.

    Article  PubMed  PubMed Central  Google Scholar 

  14. -Ward RP, Lee L, Ward TJ, Lang RM. Utilization and appropriateness of Transthoracic Echocardiography in response to the COVID-19 pandemic. J Am Soc Echocardiogr. 2020;33(6):690–1. https://doi.org/10.1016/j.echo.2020.04.006. Epub 2020 Apr 10. PMID: 32503708; PMCID: PMC7146676.

    Article  PubMed  PubMed Central  Google Scholar 

  15. -Huang S, Vignon P, Mekontso-Dessap A, Tran S, Prat G, Chew M, Balik M, Sanfilippo F, Banauch G, Clau-Terre F, Morelli A, De Backer D, Cholley B, Slama M, Charron C, Goudelin M, Bagate F, Bailly P, Blixt PJ, Masi P, Evrard B, Orde S, Mayo P, McLean AS, Vieillard-Baron A, ECHO-COVID research group. Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study). Intensive Care Med. 2022;48(6):667–78. https://doi.org/10.1007/s00134-022-06685-2. Epub 2022 Apr 21. PMID: 35445822; PMCID: PMC9022062.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. -Valenzuela ED, Mercado P, Pairumani R, Medel JN, Petruska E, Ugalde D, Morales F, Eisen D, Araya C, Montoya J, Gonzalez A, Rovegno M, Ramirez J, Aguilera J, Hernández G, Bruhn A, Slama M, Bakker J. Cardiac function in critically ill patients with severe COVID: a prospective cross-sectional study in mechanically ventilated patients. J Crit Care. 2022;72:154166. Epub 2022 Oct 13. PMID: 36244256; PMCID: PMC9557772.

    Article  PubMed  PubMed Central  Google Scholar 

  17. -Kim J, Volodarskiy A, Sultana R, Pollie MP, Yum B, Nambiar L, Tafreshi R, Mitlak HW, RoyChoudhury A, Horn EM, Hriljac I, Narula N, Kim S, Ndhlovu L, Goyal P, Safford MM, Shaw L, Devereux RB, Weinsaft JW. Prognostic utility of right ventricular remodeling over conventional risk stratification in patients with COVID-19. J Am Coll Cardiol. 2020;76(17):1965–77. PMID: 33092732; PMCID: PMC7572068.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. -Paternoster G, Bertini P, Innelli P, Trambaiolo P, Landoni G, Franchi F, Scolletta S, Guarracino F. Right ventricular dysfunction in patients with COVID-19: a systematic review and Meta-analysis. J Cardiothorac Vasc Anesth. 2021;35(11):3319–24. https://doi.org/10.1053/j.jvca.2021.04.008. Epub 2021 Apr 11. PMID: 33980426; PMCID: PMC8038863.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. -Willis J, Augustine D, Shah R, Stevens C, Easaw J. Right ventricular normal measurements: time to index? J Am Soc Echocardiogr. 2012;25(12):1259–67. https://doi.org/10.1016/j.echo.2012.06.015. Epub 2012 Jul 12. PMID: 22795198.

    Article  PubMed  Google Scholar 

  20. -Moody WE, Mahmoud-Elsayed HM, Senior J, Gul U, Khan-Kheil AM, Horne S, Banerjee A, Bradlow WM, Huggett R, Hothi SS, Shahid M, Steeds RP. Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race. CJC Open. 2021;3(1):91–100. https://doi.org/10.1016/j.cjco.2020.09.016. Epub 2020 Sep 20. Erratum in: CJC Open. 2021;3(2):227. PMID: 32984798; PMCID: PMC7502228.

  21. -Sanfilippo F, Huang S, Herpain A, Balik M, Chew MS, Clau-Terré F, Corredor C, De Backer D, Fletcher N, Geri G, Mekontso-Dessap A, McLean A, Morelli A, Orde S, Petrinic T, Slama M, van der Horst ICC, Vignon P, Mayo P, Vieillard-Baron A. The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies. Intensive Care Med. 2021;47(1):1–13. https://doi.org/10.1007/s00134-020-06262-5. Epub 2020 Dec 4. PMID: 33275163.

    Article  PubMed  Google Scholar 

  22. -Messina A, Sanfilippo F, Milani A, Calabrò L, Negri K, Monge García MI, Astuto M, Vieillard-Baron A, Cecconi M. COVID-19-related echocardiographic patterns of cardiovascular dysfunction in critically ill patients: a systematic review of the current literature. J Crit Care. 2021;65:26–35. Epub 2021 May 25. PMID: 34082252; PMCID: PMC8146405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina

    Issac Cheong, Victoria Otero Castro, Federico Matías Álvarez Vilariño, Raúl Alejandro Gómez & Mariano Andrés Furche

  2. Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina

    Issac Cheong, Pablo Martín Merlo & Francisco Marcelo Tamagnone

Authors
  1. Issac Cheong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victoria Otero Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federico Matías Álvarez Vilariño
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raúl Alejandro Gómez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mariano Andrés Furche
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pablo Martín Merlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francisco Marcelo Tamagnone
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: IC; Methodology: IC; Formal analysis and investigation: IC, FMAV, VOC, RAG; Writing – original draft preparation: IC; Writing – review and editing: IC, VOC, FMAV, RAG; Supervision: IC, RAG, MAF, PMM, FMT.

Corresponding author

Correspondence to Issac Cheong.

Ethics declarations

Competing interests

The authors declare no competing interests.

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

The authors have no relevant financial of non-financial interests to disclose.

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheong, I., Otero Castro, V., Álvarez Vilariño, F.M. et al. Predicting mortality in severe Covid-19 Pneumonia: the role of right ventricular dysfunction. J Clin Monit Comput 38, 131–137 (2024). https://doi.org/10.1007/s10877-023-01092-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-023-01092-4

Search

Navigation