乌鸦传媒

Right ventricular (RV) dilation was linked to in-hospital mortality among COVID-19 patients at one New York City hospital, researchers reported.

That abnormal echocardiographic finding was observed in 31% of the 110 people hospitalized with the infection from March 26 to April 22 of this year, according to a group led by Edgar Argulian, MD, MPH, of Mount Sinai Morningside Hospital in New York City.

Rates of in-hospital mortality were 41% for this subset with RV dilation compared with 11% among other patients.

RV enlargement was the sole predictor of mortality on multivariable analysis (OR 4.5, 95% CI 1.5-13.7), the investigators showed in a preliminary report published .

"Clinicians can use bedside echocardiography as a readily available tool to identify patients with COVID-19 infection at the highest risk of adverse hospital outcomes," Argulian suggested in a Mount Sinai press release.

Of the 10 patients with RV enlargement on echocardiography who also got CT angiography, five had evidence of pulmonary embolism, they noted.

"The mechanism of RV dilation is likely multifactorial and includes thrombotic events, hypoxemic vasoconstriction, cytokine milieu, and direct viral damage," the authors suggested.

Their group used bedside echocardiography with portable ultrasound machines, prioritizing time efficiency and appropriate use of PPE each time. The images were interpreted by echocardiography attendings.

The retrospective study included 110 consecutive COVID-19 patients who got these echocardiograms (five were excluded due to poor image quality). Mean age was 66 years, and women accounted for 36% of the cohort.

At the time of echocardiography, 30% of patients were intubated and mechanically ventilated.

RV dilation was defined as basal diastolic RV diameter >4.1 cm in the right ventricle-focused apical view and/or basal right-to-left ventricular diameter ratio of ≥0.9 in the apical 4-chamber view.

People with RV dilation had a notably higher frequency of renal dysfunction, Argulian's group noted. This subgroup also had more RV hypokinesis and moderate-or-severe tricuspid regurgitation.

No between-group differences were found in either anticoagulation use or left ventricular function at the time of the echocardiographic examination.

Study authors cautioned that their study was limited by the small sample and retrospective, single-center design.

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