1
|
Tonini A, Vergara C, Regazzoni F, Dede' L, Scrofani R, Cogliati C, Quarteroni A. A mathematical model to assess the effects of COVID-19 on the cardiocirculatory system. Sci Rep 2024; 14:8304. [PMID: 38594376 PMCID: PMC11004160 DOI: 10.1038/s41598-024-58849-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Impaired cardiac function has been described as a frequent complication of COVID-19-related pneumonia. To investigate possible underlying mechanisms, we represented the cardiovascular system by means of a lumped-parameter 0D mathematical model. The model was calibrated using clinical data, recorded in 58 patients hospitalized for COVID-19-related pneumonia, to make it patient-specific and to compute model outputs of clinical interest related to the cardiocirculatory system. We assessed, for each patient with a successful calibration, the statistical reliability of model outputs estimating the uncertainty intervals. Then, we performed a statistical analysis to compare healthy ranges and mean values (over patients) of reliable model outputs to determine which were significantly altered in COVID-19-related pneumonia. Our results showed significant increases in right ventricular systolic pressure, diastolic and mean pulmonary arterial pressure, and capillary wedge pressure. Instead, physical quantities related to the systemic circulation were not significantly altered. Remarkably, statistical analyses made on raw clinical data, without the support of a mathematical model, were unable to detect the effects of COVID-19-related pneumonia in pulmonary circulation, thus suggesting that the use of a calibrated 0D mathematical model to describe the cardiocirculatory system is an effective tool to investigate the impairments of the cardiocirculatory system associated with COVID-19.
Collapse
Affiliation(s)
- Andrea Tonini
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy.
| | - Christian Vergara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, Milan, Italy
| | | | - Luca Dede'
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Roberto Scrofani
- UOC Cardiochirurgia Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Chiara Cogliati
- Internal Medicine, L. Sacco Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Papageorgiou ST, Damdoumis S, Goulis D, Tzikas S, Giannakoulas G. The Effect of Pulmonary Hypertension on Mortality and Intensive Care Unit Admission in Patients With SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis. Heart Lung Circ 2024:S1443-9506(24)00076-3. [PMID: 38600017 DOI: 10.1016/j.hlc.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 04/12/2024]
Abstract
AIM Severe COVID-19 can cause acute respiratory distress syndrome, hypoxia, systemic complications, and increased mortality. Pulmonary hypertension (PH) is a major global health issue associated with worsening symptoms and increased mortality. This systematic review aimed to assess the influence of PH onset among COVID-19 patients on all-cause mortality and intensive care unit (ICU) admission. METHOD An unrestricted search of five databases up to June 2022 was undertaken. Pulmonary hypertension was assessed using transthoracic echocardiogram, computed tomography, or right heart catheterisation. After duplicate screening, data extraction, and risk of bias assessment, random effects meta-analyses of odds ratios (OR) and their 95% confidence intervals (CI) were performed for all-cause mortality and ICU admission. RESULTS From the 26 studies that were included (3,373 patients, 76% males, median age 62.6 years), PH in COVID-19 patients was significantly associated with higher odds for all-cause mortality (26 studies; OR 3.89; 95% CI 2.85-5.31; p<0.001) and higher odds for ICU admission (six studies; OR 2.50; 95% CI 1.69-3.70; p<0.001). Meta-regression/subgroup analyses by patient demographics, comorbidities, or therapeutic regimens, and sensitivity analyses did not find any differences. CONCLUSION Evidence from observational studies indicates that PH in COVID-19 patients is associated with increased odds of mortality and ICU admission.
Collapse
Affiliation(s)
- Stefanos T Papageorgiou
- Department of Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.
| | - Savvas Damdoumis
- Aristotle University of Thessaloniki, Faculty of Sciences, School of Biology, Department of Genetics, Development and Molecular Biology, Thessaloniki, Greece
| | - Dimitrios Goulis
- Unit of Reproductive Endocrinology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Giannakoulas
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
3
|
Estoos EM, Jocham KP, Zhang C, Benson LM, Milas A, Zakhary B. Optimal positive end-expiratory pressure reduces right ventricular dysfunction in COVID-19 patients on venovenous extracorporeal membrane oxygenation: A retrospective single-center study. J Crit Care 2023; 75:154274. [PMID: 36764115 PMCID: PMC9908009 DOI: 10.1016/j.jcrc.2023.154274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
While mechanical ventilation practices on venovenous extracorporeal membrane oxygenation (VV ECMO) are variable, most institutions utilize a lung rest strategy utilizing relatively low positive end-expiratory pressure (PEEP). The effect of PEEP titration using esophageal manometry during VV ECMO on pulmonary and cardiac function is unknown. This was a retrospective study of 69 patients initiated on VV ECMO between March 2020 through November 2021. Patients underwent standard PEEP (typically 10 cm H2O) or optimal PEEP (PEEP titrated to an end-expiratory transpulmonary pressure 0-3 cm H2O) throughout the ECMO run. The optimal PEEP strategy had higher levels of applied PEEP (17.9 vs. 10.8 cm H2O on day 2 of ECMO), decreased incidence of hemodynamically significant RV dysfunction (4.55% vs. 44.0%, p = 0.0001), and higher survival to decannulation (72.7% vs. 44.0%, p = 0.022). Survival to discharge did not reach statistical significance (27% vs. 11%, p = 0.211). In univariate logistic regression analysis, optimal PEEP was associated with less hemodynamically significant RV dysfunction with an odds ratio (OR) of 0.06 (95% confidence interval [CI] = 0.01-0.27, p = 0.0008) and increased survival to decannulation with an OR of 3.39 (95% CI 1.23-9.79), p = 0.02), though other confounding factors may have contributed.
Collapse
Affiliation(s)
- Ethan M. Estoos
- Department of Pulmonary and Critical Care Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, United States of America,Corresponding author
| | - Kevin P. Jocham
- Department of Internal Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Chengda Zhang
- Department of Pulmonary and Critical Care Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Lauren M. Benson
- Department of Pulmonary and Critical Care Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Anamaria Milas
- Department of Pulmonary and Critical Care Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Bishoy Zakhary
- Department of Pulmonary and Critical Care Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, United States of America
| |
Collapse
|
4
|
Holby SN, Richardson TL, Laws JL, McLaren TA, Soslow JH, Baker MT, Dendy JM, Clark DE, Hughes SG. Multimodality Cardiac Imaging in COVID. Circ Res 2023; 132:1387-1404. [PMID: 37167354 PMCID: PMC10171309 DOI: 10.1161/circresaha.122.321882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Infection with SARS-CoV-2, the virus that causes COVID, is associated with numerous potential secondary complications. Global efforts have been dedicated to understanding the myriad potential cardiovascular sequelae which may occur during acute infection, convalescence, or recovery. Because patients often present with nonspecific symptoms and laboratory findings, cardiac imaging has emerged as an important tool for the discrimination of pulmonary and cardiovascular complications of this disease. The clinician investigating a potential COVID-related complication must account not only for the relative utility of various cardiac imaging modalities but also for the risk of infectious exposure to staff and other patients. Extraordinary clinical and scholarly efforts have brought the international medical community closer to a consensus on the appropriate indications for diagnostic cardiac imaging during this protracted pandemic. In this review, we summarize the existing literature and reference major societal guidelines to provide an overview of the indications and utility of echocardiography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging for the diagnosis of cardiovascular complications of COVID.
Collapse
Affiliation(s)
- S Neil Holby
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Tadarro Lee Richardson
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - J Lukas Laws
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Thomas A McLaren
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
| | - Jonathan H Soslow
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics (J.H.S.), Vanderbilt University Medical Center
| | - Michael T Baker
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Jeffrey M Dendy
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Daniel E Clark
- Division of Cardiology, Department of Internal Medicine, Stanford University School of Medicine (D.E.C.)
| | - Sean G Hughes
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
| |
Collapse
|
5
|
Malandrino D, Berni A, Fibbi B, Borellini B, Cozzi D, Norello D, Fattirolli F, Lavorini F, Olivotto I, Fumagalli C, Zocchi C, Tassetti L, Gozzi L, Marchionni N, Maggi M, Peri A. Relationship between hyponatremia at hospital admission and cardiopulmonary profile at follow-up in patients with SARS-CoV-2 (COVID-19) infection. J Endocrinol Invest 2023; 46:577-586. [PMID: 36284058 PMCID: PMC9595583 DOI: 10.1007/s40618-022-01938-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/10/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Hyponatremia occurs in about 30% of patients with pneumonia, including those with SARS-CoV-2 (COVID-19) infection. Hyponatremia predicts a worse outcome in several pathologic conditions and in COVID-19 has been associated with a higher risk of non-invasive ventilation, ICU transfer and death. The main objective of this study was to determine whether early hyponatremia is also a predictor of long-term sequelae at follow-up. METHODS In this observational study, we collected 6-month follow-up data from 189 laboratory-confirmed COVID-19 patients previously admitted to a University Hospital. About 25% of the patients (n = 47) had hyponatremia at the time of hospital admission. RESULTS Serum [Na+] was significantly increased in the whole group of 189 patients at 6 months, compared to the value at hospital admission (141.4 ± 2.2 vs 137 ± 3.5 mEq/L, p < 0.001). In addition, IL-6 levels decreased and the PaO2/FiO2 increased. Accordingly, pulmonary involvement, evaluated at the chest X-ray by the RALE score, decreased. However, in patients with hyponatremia at hospital admission, higher levels of LDH, fibrinogen, troponin T and NT-ProBNP were detected at follow-up, compared to patients with normonatremia at admission. In addition, hyponatremia at admission was associated with worse echocardiography parameters related to right ventricular function, together with a higher RALE score. CONCLUSION These results suggest that early hyponatremia in COVID-19 patients is associated with the presence of laboratory and imaging parameters indicating a greater pulmonary and right-sided heart involvement at follow-up.
Collapse
Affiliation(s)
- D Malandrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A Berni
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - B Fibbi
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
- Pituitary Diseases and Sodium Alterations Unit, Careggi University Hospital, Florence, Italy
| | - B Borellini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - D Cozzi
- Radiology Emergency Department, Careggi University Hospital, Florence, Italy
| | - D Norello
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
- Pituitary Diseases and Sodium Alterations Unit, Careggi University Hospital, Florence, Italy
| | - F Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - I Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - C Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - C Zocchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - L Tassetti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - L Gozzi
- Radiology Emergency Department, Careggi University Hospital, Florence, Italy
| | - N Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - A Peri
- Endocrinology Unit, Careggi University Hospital, Florence, Italy.
- Pituitary Diseases and Sodium Alterations Unit, Careggi University Hospital, Florence, Italy.
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
| |
Collapse
|
6
|
Javaid DM, Masood DF, Nadeem DA. Letter to the Editor: Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients. Heart Lung 2023; 58:258-259. [PMID: 36163208 PMCID: PMC9448695 DOI: 10.1016/j.hrtlng.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Dr Mustafa Javaid
- Department of Medicine, Peshawar Medical College & Kuwait Teaching Hospital, Peshawar, Pakistan
| | - Dr Faizan Masood
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Dr Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
| |
Collapse
|
7
|
Rahmati M, Koyanagi A, Banitalebi E, Yon DK, Lee SW, Il Shin J, Smith L. The effect of SARS-CoV-2 infection on cardiac function in post-COVID-19 survivors: A systematic review and meta-analysis. J Med Virol 2023; 95:e28325. [PMID: 36401352 DOI: 10.1002/jmv.28325] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
The longitudinal trajectories of cardiac structure and function following SARS-CoV-2 infection are unclear. Therefore, this meta-analysis aims to elucidate the effect of SARS-CoV-2 infection on cardiac function in coronavirus disease 2019 (COVID-19) survivors after recovery. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to 1st August 2022. A systematic review and meta-analysis were performed to calculate the pooled effects size and 95% confidence interval of each outcome. A total of 21 studies including 2394 individuals (1436 post-COVID-19 cases and 958 controls) were included in the present meta-analysis. The pooled analyses compared with control groups showed a significant association between post-COVID-19 and reduced left ventricular ejection fraction (LV EF), LV end-diastolic volume (LV EDV), LV stroke volume (LV SV), mitral annular plane systolic excursion (MAPSE), global longitudinal strain, right ventricular EF (RV EF), RV EDV, RV ESV, RV SV, tricuspid annular plane systolic excursion, and increased LV mass. Subgroup analysis based on the severity of COVID-19 in the acute phase and subsequent chronic outcomes revealed that LV EF, MAPSE, RV EF, and RV ESV only decreased in studies including patients with a history of intensive care unit admission. Cardiac impairment after SARS-CoV-2 infection persisted in recovered COVID-19 patients even after 1 year. Future studies are warranted to determine the biological mechanisms underlying the long-term cardiovascular consequences of COVID-19.
Collapse
Affiliation(s)
- Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
| | - Ebrahim Banitalebi
- Department of Sport Sciences, Faculty of Literature and Human Sciences, Shahrekord University, Shahrekord, Iran
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea.,Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| |
Collapse
|
8
|
Salem Omar AM, Alam L, Talebi S, García-Sastre A, Narula J, Argulian E. Right Ventricular Abnormality in Patients Hospitalized With COVID-19 Infection During Omicron Variant Surge. Am J Cardiol 2022; 173:158-160. [PMID: 35459461 PMCID: PMC9017875 DOI: 10.1016/j.amjcard.2022.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | - Loba Alam
- Department of Cardiology at Mount Sinai Morningside
| | | | - Adolfo García-Sastre
- Department of Microbiology,Global Health and Emerging Pathogens Institute,Division of Infectious Diseases, Department of Medicine,The Tisch Cancer Institute,Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jagat Narula
- Department of Cardiology at Mount Sinai Morningside
| | | |
Collapse
|
9
|
Lafon T, Baisse A, Simonneau Y, Goudelin M, Hani Karam H, Desvaux E, Guillot MS, Evrard B, Vignon P. Identification précoce des phénotypes cardiovasculaires chez les patients en insuffisance respiratoire aiguë au cours de la première pandémie Covid-19. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : L'objectif principal était de comparer la prévalence de la dysfonction ventriculaire gauche (VG) et/ ou droite (VD) des patients admis au service d'urgence (SU) avec une insuffisance respiratoire aiguë (IRA) secondaire ou non à une pneumopathie à Covid-19.
Méthodes : Pendant un mois, nous avons inclus (24/7) de façon prospective les patients de l'unité de Covid-19 du SU qui présentaient une IRA. Pour chaque patient, un test RT-PCR, une tomodensitométrie thoracique et une échographie cardiaque de niveau 2 et pulmonaire étaient systématiquement réalisés avant toute intervention thérapeutique. Chaque patient était classé selon les phénotypes cardiovasculaires suivants : insuffisance VG, insuffisance VD, hypovolémie ± hyperkinésie et profil hémodynamique normal.
Résultats : Parmi les 517 patients admis pendant la période d'étude, 78 présentaient une IRA (15 %) et 62 ont bénéficié d'une échocardiographie de niveau 2 (âge : 73 ± 14 ans ; SpO2 : 90 ± 4 % ; lactate : 2,1 ± 1,3 mmol/l). Le diagnostic de la Covid-19 a été établi pour 22 patients (35 %). L'insuffisance VG (15 [38 %] vs 2 [9 %] ; p = 0,016) et celle VD (12 [30 %] vs 1 [5 %] ; p = 0,018) étaient plus souvent observées dans le groupe témoin que chez les patients ayant une pneumopathie à Covid-19. Inversement, les patients Covid-19 avaient plus fréquemment un profil hémodynamique normal ou une hypovolémie associée ou non à une vasoplégie (20 [91 %] vs 21 [53 %] ; p = 0,002). La mortalité intrahospitalière était de 18 % ( n = 11). Tous les patients atteints de la Covid-19 présentant une insuffisance VG et/ou VD précoce sont décédés pendant leur hospitalisation.
Conclusions : La dysfonction VG et celle VD étaient plus fréquentes chez les patients non atteints de la Covid-19, alors que les patients atteints de Covid-19 avaient un phénotype cardiovasculaire normal ou hypovolémique.
Collapse
|
10
|
Holmqvist J, Beck‐Friis J, Jensen C, Dalla K, Mårdstam S, Christensen J, Nordén N, Widing H, Rosén‐Wetterholm E, Cavefors O, Yilmaz A, Cronhjort M, Redfors B, Oras J. Cardiac dysfunction and mortality in critically ill patients with COVID-19: A Swedish multicentre observational study. Acta Anaesthesiol Scand 2022; 66:606-614. [PMID: 35122232 PMCID: PMC9111275 DOI: 10.1111/aas.14039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence and importance of cardiac dysfunction in critically ill patients with COVID-19 in Sweden is not yet established. The aim of the study was to assess the prevalence of cardiac dysfunction and elevated pulmonary artery pressure (PAP), and its influence on mortality in patients with COVID-19 in intensive care in Sweden. METHODS This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 h from admission and again after 4 to 7 days. Cardiac dysfunction was defined as left ventricular (LV) dysfunction (ejection fraction <50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (defined as TAPSE <17 mm or visually assessed moderate/severe RV dysfunction). RESULTS We included 132 patients, of whom 127 (96%) were intubated. Cardiac dysfunction was found in 42 (32%) patients. Most patients had cardiac dysfunction at the first assessment (n = 35) while a few developed cardiac dysfunction later (n = 7) and some changed type of dysfunction (n = 3). LV dysfunction was found in 21 and RV dysfunction in 19 patients, while 5 patients had combined dysfunction. Elevated PAP was found in 34 patients (26%) and was more common in patients with RV dysfunction. RV dysfunction and elevated PAP were independently associated with an increased risk of death (OR 3.98, p = .013 and OR 3.88, p = .007, respectively). CONCLUSIONS Cardiac dysfunction occurs commonly in critically ill patients with COVID-19 in Sweden. RV dysfunction and elevated PAP are associated with an increased risk of death.
Collapse
Affiliation(s)
- Jacob Holmqvist
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Sahlgrenska Gothenburg Sweden
| | - Josefine Beck‐Friis
- Department of Infectious Diseases Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Infectious Diseases Sahlgrenska University Hospital Gothenburg Sweden
| | - Carl Jensen
- Department of Anesthesiology and Intensive Care Medicine NU Hospital Group Trollhättan Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Mölndal Gothenburg Sweden
| | - Simon Mårdstam
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Jens Christensen
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Nina Nordén
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Mölndal Gothenburg Sweden
| | - Hannes Widing
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Elin Rosén‐Wetterholm
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Oscar Cavefors
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Sahlgrenska Gothenburg Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Infectious Diseases Sahlgrenska University Hospital Gothenburg Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Björn Redfors
- Department of Cardiology Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Jonatan Oras
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Sahlgrenska Gothenburg Sweden
| |
Collapse
|
11
|
Mohamad Y, El-Sherif R, Adel Gawish M, Abdrabo I, Mowafy HH. Right Ventricular Assessment in Critically Ill COVID-19 Patients and its Prognostic Importance. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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.
Collapse
|
12
|
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; 44:1360-1370. [PMID: 34528706 PMCID: PMC8495092 DOI: 10.1002/clc.23719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
There is limited evidence about the prognostic utility of right ventricular dysfunction (RVD) in patients with coronavirus disease 2019 (COVID‐19). We assessed the association between RVD and mortality in COVID‐19 patients. We searched electronic databases from inception to February 15, 2021. RVD was defined based on the following echocardiographic variables: tricuspid annular plane systolic excursion (TAPSE), tricuspid S′ peak systolic velocity, fractional area change (FAC), and right ventricular free wall longitudinal strain (RVFWLS). All meta‐analyses were performed using a random‐effects model. Nineteen cohort studies involving 2307 patients were included. The mean age ranged from 59 to 72 years and 65% of patients were male. TAPSE (mean difference [MD], −3.13 mm; 95% confidence interval [CI], −4.08–−2.19), tricuspid S′ peak systolic velocity (MD, −0.88 cm/s; 95% CI, −1.68 to −0.08), FAC (MD, −3.47%; 95% CI, −6.21 to −0.72), and RVFWLS (MD, −5.83%; 95% CI, −7.47–−4.20) were significantly lower in nonsurvivors compared to survivors. Each 1 mm decrease in TAPSE (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.08–1.37), 1% decrease in FAC (aHR, 1.09; 95% CI, 1.04–1.14), and 1% increase in RVFWLS (aHR, 1.33; 95% CI, 1.19–1.48) were independently associated with higher mortality. RVD was significantly associated with higher mortality using unadjusted risk ratio (2.05; 95% CI, 1.27–3.31), unadjusted hazard ratio (3.37; 95% CI, 1.72–6.62), and adjusted hazard ratio (aHR, 2.75; 95% CI, 1.52–4.96). Our study shows that echocardiographic parameters of RVD were associated with an increased risk of mortality in COVID‐19 patients.
Collapse
Affiliation(s)
- Carlos Diaz-Arocutipa
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.,Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru.,Programa de Atención Domiciliaria (PADOMI), Lima, Peru
| | | | - Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|