Right Ventricular Abnormality in Patients Hospitalized With COVID-19 Infection During Omicron Variant Surge

Different clinical characteristics and outcomes of adult hospitalized SARS-CoV-2 pneumonia patients complicated by cardiovascular events during the first, delta and omicron waves of COVID-19

Background

The effects of SARS-CoV-2 have varied between significant waves of hospitalization.

Research question

Are cardiovascular complications different among the first, delta and omicron waves of hospitalized COVID-19 pneumonia patients?

Study design and methods

This was a multi-centre retrospective study of patients hospitalized with SARS-CoV-2 pneumonia: 632 were hospitalized during the first wave (March-July 2020), 1013 during the delta wave (September 2020-March 2021), and 323 during the omicron wave (January 2022-July 2022). Patients were stratified by wave and occurrence of cardiovascular events.

Results

Among all hospitalized patients with cardiovascular events, patients in the omicron wave were younger (62.4 ± 14 years) than patients in the first wave (67.4 ± 7.8 years) and the delta wave (66.9 ± 12.6 years) and had a higher proportion of non-Hispanic White people than in the first wave (78.6% vs. 61.7%). For COVID-19 patients who suffered from cardiovascular events, the omicron wave patients had significantly higher neutrophil/lymphocyte ratio, white blood cell and platelet counts when compared to the first wave. Omicron wave patients had significantly lower albumin and B-type natriuretic peptide levels (only 5.8% of the first wave and 14.6% of the delta wave) when compared to either the first wave or delta wave patients. In COVID-19 patients who suffered cardiovascular events during hospitalization, mortality rate in the omicron wave (26.8%) was significantly lower than the first wave (48.3%), time to mortality for non-survivors of COVID-19 patients who suffered cardiovascular events was significantly longer in the omicron wave (median 16 days) than in the first wave (median 10 days).

Conclusions

Younger and white patients were affected with cardiovascular complications more often by the omicron variant. Despite higher neutrophil/lymphocyte ratio and WBC counts, the omicron patients with cardiovascular events showed lower heart injuries, lower mortality and longer time to mortality for non-survivors when compared to the first and delta waves.

Association Between Baseline Echocardiographic Parameters and Acute Coronavirus Disease 2019 Infection in Hospitalized Patients

Background The current study aimed to examine the association between baseline clinical and echocardiographic parameters with new-onset coronavirus disease 2019 (COVID-19) infection. Methodology We retrospectively enrolled consecutive hospitalized patients from our center during the national outbreak of the COVID-19 pandemic in China. Overall, 100 patients were enrolled, including 38 patients with COVID-19 infection. Results Compared with those without infection, patients with COVID-19 infection were more likely male (63.2% vs. 35.5%, p = 0.008), were older (59.08 vs. 52.35 years, p = 0.022), had higher heart failure (31.6% vs. 11.3%, p = 0.018) and hypertension (52.6% vs. 30.6%, p = 0.036) rates, had lower left ventricular ejection fraction (LVEF) (61.16% vs. 65.76%, p = 0.018), had higher A-wave velocity (86.84 vs. 73.63 cm/s, p = 0.003), and had and lower E/A ratio (0.85 vs 1.04, p = 0.015). On univariate and multivariate analysis, baseline echocardiographic parameters (LVEF and A-wave velocity) were independent risk factors for COVID-19 infection. There were no significant changes in echocardiographic parameters during the one-month follow-up period in patients infected and not infected with COVID-19. Conclusions In conclusion, baseline echocardiographic parameters were significantly associated with acute COVID-19 infection.

A cross-sectional study of echocardiographic characteristics of patients diagnosed with SARS-CoV-2 delta strain

BACKGROUND

The delta variant of SARS-CoV-2 has been associated with increased mortality and multi-organ failure, affecting various systems in the body. Cardiovascular manifestations including arrhythmias, heart failure, myocarditis, myocardial damage, and thromboembolism are commonly observed in patients infected with the delta variant.

MATERIALS AND METHODS

This study enrolled 106 individuals who tested positive for the delta strain of SARS-CoV-2 using real-time RT-PCR between May 25, 2020, and October 15, 2021. All patients underwent 2-D echocardiography, and based on the severity of their infection, were divided into two groups: serious and non-serious.

RESULTS

Univariate correlation analysis showed significant positive correlations between right ventricular (RV) diameter and hs-TnI and D-dimer levels. Conversely, left ventricular ejection fraction (LVEF) was negatively correlated with hs-TnI, C-reactive protein (CRP), and D-dimer levels. Additionally, RV fractional area change (RV-FAC) showed a negative correlation with D-dimer and hs-TnI levels but not with CRP levels.

DISCUSSION

RV dysfunction has been identified as an important predictor of mortality in various patient populations, including those infected with the delta variant of SARS-CoV-2. A significant proportion of severe delta variant cases require mechanical ventilation, which can have hemodynamic effects on the ventricular performance. Mechanical ventilation can increase pulmonary arterial pressure and worsen right heart dysfunction, especially when lung-protective ventilation strategies are not optimized.

CONCLUSIONS

Our study highlights that patients with severe delta variants, particularly those with cardiac injury, may exhibit biventricular systolic dysfunction. Echocardiographic parameters such as LVEF, RV diameter, and RV-FAC were found to be associated with laboratory markers of poor prognosis, including elevated hs-TnI, CRP, and D-dimer levels. 2-D echocardiography can be a valuable tool in identifying early signs of ventricular dysfunction, aiding in the management of this patient population.

Association between Right Ventricular Dysfunction and In-Hospital Mortality in Surges of SARS-CoV-2 Infection Attributed to the Alpha, Delta, and Omicron Variants

Background

Right ventricular (RV) dysfunction in acute COVID-19 was reported to be associated with poor prognosis. We studied the association between parameters of RV dysfunction and in-hospital mortality during the surges caused by different SARS-CoV-2 variants.

Methods

In a retrospective single-center study, we enrolled 648 consecutive patients hospitalized with COVID-19 [66 (10 %) hospitalized during the alpha variant surge, 433 (67 %) during the delta variant surge, and 149 (23 %), during the omicron variant surge]. Patients were reported from a hospital with an underreported population of mostly African American and Hispanic patients. Patients were followed for a median of 11 days during which in-hospital death occurred in 155 (24 %) patients [Alpha wave: 25 (38 %), Delta Wave: 112 (26 %), Omicron wave: 18 (12 %), p < 0.001].

Results

RV dysfunction occurred in 210 patients (alpha: 32 %, 26 %, delta: 29 %, and omicron: 49 %, p < 0.001) and was associated with higher mortality across waves, however, independently predicted in-hospital mortality in the Alpha (HR = 5.1, 95 % CI: 2.06–12.5) and Delta surges (HR = 1.6, 95 % CI: 1.11–2.44), but not in the Omicron surge. When only patients with RV dysfunction were compared, the mortality risk was found to decrease significantly from the Alpha (HR = 13.6, 95 % CI: 3.31–56.3) to the delta (HR = 1.93, 95 % CI: 1.25–2.96) and to the Omicron waves (HR = 11, 95 % CI: 0.6–20.8).

Conclusions

RV dysfunction continues to occur in all strains of the SARS-CoV-2 virus, however, the mortality risk decreased from wave to wave likely due to evolution of better therapeutics, increase rate of vaccination, or viral mutations resulting in decrease virulence.

Registration number of clinical studies: BronxCare Hospital center institutional review board under the number 05 13 21 04.