RV Dysfunction Slams Survival in Acute COVID, Flu, Pneumonia

The study covered in this summary was published in medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

Right ventricular (RV) dilation or dysfunction in patients hospitalized with acute COVID-19 is associated with an elevated risk for in-hospital death.
The impact of RV dilation or dysfunction on in-hospital mortality is similar for patients with acute COVID-19 and those with influenza, pneumonia, or acute respiratory distress syndrome (ARDS), but COVID-19 patients have greater absolute in-hospital mortality.
RV dilatation or dysfunction in patients with acute COVID-19 is associated with a diagnosis of venous thromboembolism and subsequent intubation and mechanical ventilation.

Why This Matters

Right ventricular dysfunction increases mortality risk in acute COVID-19, and this study shows that RV dilation and dysfunction among such hospitalized patients has a similar impact on risk for in-hospital death in acute COVID-19 and in other respiratory illnesses.
The findings suggest that abnormal RV findings should be considered a mortality risk marker in patients with acute respiratory illness, especially COVID-19.

Study Design

The retrospective study involved 225 consecutive patients admitted for acute COVID-19 from March 2020 to February 2021 at four major hospitals in the same metropolitan region and a control group of 6150 adults admitted to the hospital for influenza, pneumonia, or ARDS; mean age in the study cohort was 63 years.
All participants underwent echocardiography during their hospitalization, including evaluation of any RV dilation or dysfunction.
Associations between RV measurements and in-hospital mortality, the primary outcome, were adjusted for potential confounders.

Key Results

Patients in the COVID-19 group were more likely than those in the control patients to be male (66% vs 54%; P < .001), to identify as Hispanic (38% vs 15%; P < .001), and to have a higher mean body mass index (29.4 vs 27.9 kg/m²; P = .008).
Compared with the control group, patients in the COVID-19 group more often required admission to the intensive-care unit (75% vs 54%; P < .001), mechanical ventilation (P < .001), and initiation of renal replacement therapy (P = .002), and more often were diagnosed with deep-vein thrombosis or pulmonary embolism (25% vs 14%; P < .001). The median length of hospital stay was 20 days in the COVID-19 group, compared with 10 days in the control group (P < .001).
In-hospital mortality was 21.3% in the COVID-19 group and 11.8% in the control group (P = .001). Those hospitalized with COVID-19 had an adjusted relative risk (RR) of 1.54 (95% CI, 1.06 - 2.24; P = .02) for in-hospital mortality, compared with those hospitalized for other respiratory illnesses.
Mild RV dilation was associated with an adjusted RR of 1.4 (95% CI, 1.17 - 1.69; P = .0003) for in-hospital death, and moderate to severe RV dilation was associated with an adjusted RR of 2.0 (95% CI, 1.62 - 2.47; P < .0001).
The corresponding adjusted risks for mild RV dysfunction and greater-than-mild RV dysfunction were, respectively, 1.39 (95% CI, 1.10 - 1.77; P = .007) and 1.68 (95% CI, 1.17 - 2.42; P = .005).
The RR for in-hospital mortality associated with RV dilation and dysfunction was similar in those with COVID-19 and those with other respiratory illness, but the former had a higher baseline risk that yielded a greater absolute risk in the COVID-19 group.

Limitations

The study was based primarily on a retrospective review of electronic health records, which poses a risk for misclassification.
Echocardiography was performed without blinding operators to patient clinical status, and echocardiograms were interpreted in a single university hospital system, so were not externally validated.
Because echocardiograms obtained during hospitalization could not be compared with previous echocardiograms, it could not be determined whether any of the patients had pre-existing RV dilation or dysfunction.
Strain imaging was not feasible in many cases.

Disclosures

The study received no commercial funding.
The authors disclosed no financial relationships.

This is a summary of a preprint research study, Association of Right Ventricular Dilation and Dysfunction on Echocardiogram With In-Hospital Mortality Among Patients Hospitalized with COVID-19 Compared With Other Acute Respiratory Illness, written by researchers at the University of California, San Francisco, Department of Medicine, and Zuckerberg San Francisco General Hospital, Division of Cardiology.

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