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To examine whether adverse right ventricular (RV) remodeling may be a useful prognostic indicator of risk in patients with COVID-19, researchers examined images obtained from 510 patients at three New York City hospitals who had undergone transthoracic echocardiography as part of their clinical care. RV dilation was present in 35% of patients, and RV dysfunction was present in 15%. There was a significant stepwise increase in RV dysfunction related to RV chamber size. Follow-up was based on the length of inpatient stay, which was a median of 20 days. Study-related endpoints occurred in 77% of patients, representing 45% of patients who were discharged and 32% who died. There was a higher mortality risk associated independently with RV dysfunction and dilation. Rates of survival to hospital discharge were higher among patients without adverse RV remodeling (HR, 1.39). A multivariate analysis found greater than double mortality risk in patients with versus without adverse RV remodeling independent of age and biomarker elevations.
Based on these data, adverse remodeling has an important prognostic value incremental to biomarker and clinical assessments. The authors recommend further research to determine the longer-term prognostic value of adverse RV remodeling.
This abstract is available on the publisher's site.
Coronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain.
The purpose of this study was to test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification.
Consecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at 3 New York City hospitals were studied; images were analyzed by a central core laboratory blinded to clinical and biomarker data.
In total, 510 patients (age 64 ± 14 years, 66% men) were studied; RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p = 0.007). During inpatient follow-up (median 20 days), 77% of patients had a study-related endpoint (death 32%, discharge 45%). RV dysfunction (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.49 to 4.43; p = 0.001) and dilation (HR: 1.43; 95% CI: 1.05 to 1.96; p = 0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR: 1.39; 95% CI: 1.01 to 1.90; p = 0.041). RV indices provided additional risk stratification beyond biomarker strata; risk for death was greatest among patients with adverse RV remodeling and positive biomarkers and was lesser among patients with isolated biomarker elevations (p ≤ 0.001). In multivariate analysis, adverse RV remodeling conferred a >2-fold increase in mortality risk, which remained significant (p < 0.01) when controlling for age and biomarker elevations; the predictive value of adverse RV remodeling was similar irrespective of whether analyses were performed using troponin, D-dimer, or ferritin.
Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.
JACC: Journal of the American College of Cardiology
Prognostic Utility of Right Ventricular Remodeling Over Conventional Risk Stratification in Patients With COVID-19
J Am Coll Cardiol 2020 Oct 27;76(17)1965-1977, J Kim, A Volodarskiy, R Sultana, MP Pollie, B Yum, L Nambiar, R Tafreshi, HW Mitlak, A RoyChoudhury, EM Horn, I Hriljac, N Narula, S Kim, L Ndhlovu, P Goyal, MM Safford, L Shaw, RB Devereux, JW Weinsaft