1
|
Merino-Caviedes S, Martín-Fernández M, Pérez Rodríguez MT, Martín-Fernández MÁ, Filgueiras-Rama D, Simmross-Wattenberg F, Alberola-López C. Computing thickness of irregularly-shaped thin walls using a locally semi-implicit scheme with extrapolation to solve the Laplace equation: Application to the right ventricle. Comput Biol Med 2024; 169:107855. [PMID: 38113681 DOI: 10.1016/j.compbiomed.2023.107855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
Cardiac Magnetic Resonance (CMR) Imaging is currently considered the gold standard imaging modality in cardiology. However, it is accompanied by a tradeoff between spatial resolution and acquisition time. Providing accurate measures of thin walls relative to the image resolution may prove challenging. One such anatomical structure is the cardiac right ventricle. Methods for measuring thickness of wall-like anatomical structures often rely on the Laplace equation to provide point-to-point correspondences between both boundaries. This work presents limex, a novel method to solve the Laplace equation using ghost nodes and providing extrapolated values, which is tested on three different datasets: a mathematical phantom, a set of biventricular segmentations from CMR images of ten pigs and the database used at the RV Segmentation Challenge held at MICCAI'12. Thickness measurements using the proposed methodology are more accurate than state-of-the-art methods, especially with the coarsest image resolutions, yielding mean L1 norms of the error between 43.28% and 86.52% lower than the second-best methods on the different test datasets. It is also computationally affordable. Limex has outperformed other state-of-the-art methods in classifying RV myocardial segments by their thickness.
Collapse
Affiliation(s)
- Susana Merino-Caviedes
- Laboratorio de Procesado de Imagen, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Spain.
| | - Marcos Martín-Fernández
- Laboratorio de Procesado de Imagen, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Spain.
| | | | | | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Novel Arrhythmogenic Mechanisms Program, Madrid, Spain.
| | | | - Carlos Alberola-López
- Laboratorio de Procesado de Imagen, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Spain.
| |
Collapse
|
2
|
Mansour H, Abdelhady AO, Reheim WAA, William V. Can Global Longitudinal Strain Assess Asymptomatic Subtle Left Ventricular Dysfunction in Recovered COVID-19 Patients? J Cardiovasc Echogr 2023; 33:183-188. [PMID: 38486690 PMCID: PMC10936707 DOI: 10.4103/jcecho.jcecho_6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/16/2023] [Accepted: 12/10/2023] [Indexed: 03/17/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) might be associated with cardiac injury as a part of multisystem affection in response to cytokine storms. However, left ventricular (LV) function appears preserved in most of the cases, whereas subtle LV dysfunction might happen in others. Hence, we tried to detect subtle LV dysfunction in patients with COVID-19 using global longitudinal strain (GLS). Patients and Methods We performed a single-center observational study on 90 stable patients who were recently recovered from mild to moderate COVID-19 infections. A transthoracic echocardiographic examination was done for all patients, and GLS assessment was used as an indicator of LV function. Results The population age ranged from 27 to 66 years, and the majority of patients were males (54, 73.3%). Besides, 46.7% of the included patients were smokers, 33.3% had hypertension, and 23.3% were diabetics. All the patients had normal LV internal dimensions and ejection fractions. However, 33.3% of them had subclinical LV dysfunction as expressed by reduced GLS. There was no statistically significant correlation between GLS and age, gender, or other risk factors, whereas troponin and C-reactive protein significantly correlated with GLS. Conclusions Recovered patients from recent mild to moderate COVID-19 infections might show subtle LV dysfunction as manifested by reduced GLS.
Collapse
Affiliation(s)
- Hazem Mansour
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Aly Osama Abdelhady
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Viola William
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
3
|
Weisz SH, Attena E, Caturano A, Annunziata A, Halasz G, Conte M, Parisi V, Severino L, Sasso FC, Fiorentino G, Severino S, Russo V. Right ventricular electrocardiographic abnormalities among hospitalized COVID-19 patients: Simple marker of worst clinical outcome. J Electrocardiol 2023; 80:162-165. [PMID: 37451132 DOI: 10.1016/j.jelectrocard.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Sara Hana Weisz
- Division of Cardiology, Cotugno Hospital - AORN dei Colli, Naples, Italy
| | - Emilio Attena
- Division of Cardiology, Monaldi Hospital - AORN dei Colli, Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Annunziata
- Subintensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital -AORN dei Colli, Naples, Italy
| | - Geza Halasz
- Cardiology Department, Guglielmo Da Saliceto Hospital, Piacenza, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Laura Severino
- Division of Cardiology, Cotugno Hospital - AORN dei Colli, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Fiorentino
- Subintensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital -AORN dei Colli, Naples, Italy
| | - Sergio Severino
- Division of Cardiology, Cotugno Hospital - AORN dei Colli, Naples, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy.
| |
Collapse
|
4
|
Beyls C, Vial J, Lefebvre T, Muller C, Hanquiez T, Besserve P, Guilbart M, Haye G, Bernasinski M, Huette P, Dupont H, Abou-Arab O, Jounieaux V, Mahjoub Y. Prognostic value of right ventricular dilatation on computed tomography pulmonary angiogram for predicting adverse clinical events in severe COVID-19 pneumonia. Front Med (Lausanne) 2023; 10:1213775. [PMID: 37583421 PMCID: PMC10425267 DOI: 10.3389/fmed.2023.1213775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/03/2023] [Indexed: 08/17/2023] Open
Abstract
Background Right ventricle dilatation (RVD) is a common complication of non-intubated COVID-19 pneumonia caused by pro-thrombotic pneumonitis, intra-pulmonary shunting, and pulmonary vascular dysfunction. In several pulmonary diseases, RVD is routinely measured on computed tomography pulmonary angiogram (CTPA) by the right ventricle-to-left ventricle (LV) diameter ratio > 1 for predicting adverse events. Objective The aim of the study was to evaluate the association between RVD and the occurrence of adverse events in a cohort of critically ill non-intubated COVID-19 patients. Methods Between February 2020 and February 2022, non-intubated patients admitted to the Amiens University Hospital intensive care unit for COVID-19 pneumonia with CTPA performed within 48 h of admission were included. RVD was defined by an RV/LV diameter ratio greater than one measured on CTPA. The primary outcome was the occurrence of an adverse event (renal replacement therapy, extracorporeal membrane oxygenation, 30-day mortality after ICU admission). Results Among 181 patients, 62% (n = 112/181) presented RVD. The RV/LV ratio was 1.10 [1.05-1.18] in the RVD group and 0.88 [0.84-0.96] in the non-RVD group (p = 0.001). Adverse clinical events were 30% and identical in the two groups (p = 0.73). In Receiving operative curves (ROC) analysis, the RV/LV ratio measurement failed to identify patients with adverse events. On multivariable Cox analysis, RVD was not associated with adverse events to the contrary to chest tomography severity score > 10 (hazards ratio = 1.70, 95% CI [1.03-2.94]; p = 0.04) and cardiovascular component (> 2) of the SOFA score (HR = 2.93, 95% CI [1.44-5.95], p = 0.003). Conclusion Right ventricle (RV) dilatation assessed by RV/LV ratio was a common CTPA finding in non-intubated critical patients with COVID-19 pneumonia and was not associated with the occurrence of clinical adverse events.
Collapse
Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Jeremie Vial
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - Thomas Lefebvre
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Charlotte Muller
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Thomas Hanquiez
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Patricia Besserve
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Mathieu Guilbart
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Guillaume Haye
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Michael Bernasinski
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Pierre Huette
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Vincent Jounieaux
- Department of Pneumology, Amiens University Hospital, Amiens, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| |
Collapse
|
5
|
Militaru S, Mihu A, Genunche-Dumitrescu AV, Neagoe CD, Avramescu TE, Istratoaie O, Gheonea IA, Militaru C. Multimodality Cardiac Imaging in COVID-19 Infection. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1223. [PMID: 37512035 PMCID: PMC10384118 DOI: 10.3390/medicina59071223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
COVID-19 infection often produces cardiovascular complications, which can range from mild to severe and influence the overall prognosis. Imaging is the cornerstone for diagnosing initial COVID-19 cardiovascular involvement as well as treatment guidance. In this review, we present the current state of the literature on this subject while also emphasizing possible algorithms for indicating and executing these investigations.
Collapse
Affiliation(s)
- Sebastian Militaru
- Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
- Cardiomed Clinic, 200513 Craiova, Romania
| | - Anca Mihu
- Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
- Cardiomed Clinic, 200513 Craiova, Romania
| | | | | | - Taina Elena Avramescu
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
| | - Octavian Istratoaie
- Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
| | | | - Cristian Militaru
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
- Cardiomed Clinic, 200513 Craiova, Romania
| |
Collapse
|
6
|
Ltaief Z, Yerly P, Liaudet L. Pulmonary Hypertension in Left Heart Diseases: Pathophysiology, Hemodynamic Assessment and Therapeutic Management. Int J Mol Sci 2023; 24:9971. [PMID: 37373119 PMCID: PMC10298585 DOI: 10.3390/ijms24129971] [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: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Pulmonary hypertension (PH) associated with left heart diseases (PH-LHD), also termed group 2 PH, represents the most common form of PH. It develops through the passive backward transmission of elevated left heart pressures in the setting of heart failure, either with preserved (HFpEF) or reduced (HFrEF) ejection fraction, which increases the pulsatile afterload of the right ventricle (RV) by reducing pulmonary artery (PA) compliance. In a subset of patients, progressive remodeling of the pulmonary circulation resulted in a pre-capillary phenotype of PH, with elevated pulmonary vascular resistance (PVR) further increasing the RV afterload, eventually leading to RV-PA uncoupling and RV failure. The primary therapeutic objective in PH-LHD is to reduce left-sided pressures through the appropriate use of diuretics and guideline-directed medical therapies for heart failure. When pulmonary vascular remodeling is established, targeted therapies aiming to reduce PVR are theoretically appealing. So far, such targeted therapies have mostly failed to show significant positive effects in patients with PH-LHD, in contrast to their proven efficacy in other forms of pre-capillary PH. Whether such therapies may benefit some specific subgroups of patients (HFrEF, HFpEF) with specific hemodynamic phenotypes (post- or pre-capillary PH) and various degrees of RV dysfunction still needs to be addressed.
Collapse
Affiliation(s)
- Zied Ltaief
- Service of Adult Intensive Care Medicine, University Hospital, 1011 Lausanne, Switzerland;
| | - Patrick Yerly
- Service of Cardiology, University Hospital, 1011 Lausanne, Switzerland;
| | - Lucas Liaudet
- Service of Adult Intensive Care Medicine, University Hospital, 1011 Lausanne, Switzerland;
| |
Collapse
|
7
|
Ilardi F, Crisci M, Calabrese C, Scognamiglio A, Arenga F, Manzo R, Mariniello DF, Allocca V, Annunziata A, D'Andrea A, Merenda R, Monda V, Esposito G, Fiorentino G. Effects on Right Ventricular Function One Year after COVID-19-Related Pulmonary Embolism. J Clin Med 2023; 12:jcm12113611. [PMID: 37297806 DOI: 10.3390/jcm12113611] [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: 03/31/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to investigate the presence of subclinical cardiac dysfunction in recovered coronavirus disease 2019 (COVID-19) patients, who were stratified according to a previous diagnosis of pulmonary embolism (PE) as a complication of COVID-19 pneumonia. Out of 68 patients with SARS-CoV-2 pneumonia followed up for one year, 44 patients (mean age 58.4 ± 13.3, 70% males) without known cardiopulmonary disease were divided in two groups (PE+ and PE-, each comprising 22 patients) and underwent clinical and transthoracic echocardiographic examination, including right-ventricle global longitudinal strain (RV-GLS), and RV free wall longitudinal strain (RV-FWLS). While no significant differences were found in the left- or right-heart chambers' dimensions between the two study groups, the PE+ patients showed a significant reduction in RV-GLS (-16.4 ± 2.9 vs. -21.6 ± 4.3%, p < 0.001) and RV-FWLS (-18.9 ± 4 vs. -24.6 ± 5.12%, p < 0.001) values compared to the PE- patients. According to the ROC-curve analysis, RV-FWLS < 21% was the best cut-off with which to predict PE diagnosis in patients after SARS-CoV-2 pneumonia (sensitivity 74%, specificity 89%, area under the curve = 0.819, p < 0.001). According to the multivariate logistic regression model, RV-FWLS < 21% was independently associated with PE (HR 34.96, 95% CI:3.24-377.09, p = 0.003) and obesity (HR 10.34, 95% CI:1.05-101.68, p = 0.045). In conclusion, in recovered COVID-19 patients with a history of PE+, there is a persistence of subclinical RV dysfunction one year after the acute phase of the disease, detectable by a significant impairment in RV-GLS and RV-FWLS. A reduction in RV-FWLS of lower than 21% is independently associated with COVID-related PE.
Collapse
Affiliation(s)
- Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini, 5, 80131 Naples, Italy
| | - Mario Crisci
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, 80131 Naples, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, 80131 Naples, Italy
| | - Anna Scognamiglio
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, 80131 Naples, Italy
| | - Fortunato Arenga
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, 80131 Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini, 5, 80131 Naples, Italy
| | - Domenica F Mariniello
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, 80131 Naples, Italy
| | - Valentino Allocca
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, 80131 Naples, Italy
| | - Anna Annunziata
- Department of Intensive Care, A.O.R.N dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Antonello D'Andrea
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, 80131 Naples, Italy
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, 84014 Nocera Inferiore, Italy
| | - Raffaele Merenda
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, 80131 Naples, Italy
| | - Vittorio Monda
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini, 5, 80131 Naples, Italy
| | - Giuseppe Fiorentino
- Department of Intensive Care, A.O.R.N dei Colli, Monaldi Hospital, 80131 Naples, Italy
| |
Collapse
|
8
|
Brown TN, Brogan TV. Right ventricular dysfunction in patients with acute respiratory distress syndrome receiving venovenous extracorporeal membrane oxygenation. Front Cardiovasc Med 2023; 10:1027300. [PMID: 37265572 PMCID: PMC10229794 DOI: 10.3389/fcvm.2023.1027300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/10/2023] [Indexed: 06/03/2023] Open
Abstract
Acute respiratory distress syndrome is characterized by non-cardiogenic pulmonary edema, decreased pulmonary compliance, and abnormalities in gas exchange, especially hypoxemia. Patients with acute respiratory distress syndrome (ARDS) who receive support with venovenous (V-V) extracorporeal membrane oxygenation (ECMO) usually have severe lung disease. Many patients with ARDS have associated pulmonary vascular injury which can result in elevated pulmonary vascular resistance and right heart dysfunction. Since V-V ECMO relies upon preserved cardiac function, right heart failure has important implications for patient evaluation, management, and outcomes. Worsening right heart function complicates ARDS and disease processes. Given the increasing use of ECMO to support patients with ARDS, an understanding of right ventricular-ECMO and cardiopulmonary interactions is essential for the clinician. A narrative review of the manifestations of right heart dysfunction, as well as diagnosis and management strategies for the patient with ARDS on ECMO, is provided.
Collapse
Affiliation(s)
- Tyler N. Brown
- Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington, United States
| | - Thomas V. Brogan
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington, United States
| |
Collapse
|
9
|
Palmisano A, Vignale D, Bruno E, Peretto G, De Luca G, Campochiaro C, Tomelleri A, Agricola E, Montorfano M, Esposito A. Cardiac magnetic resonance findings in acute and post-acute COVID-19 patients with suspected myocarditis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:613-621. [PMID: 36544331 PMCID: PMC9878084 DOI: 10.1002/jcu.23416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Cardiac injury is commonly reported in COVID-19 patients, resulting associated to pre-existing cardiovascular disease, disease severity, and unfavorable outcome. Aim is to report cardiac magnetic resonance (CMR) findings in patients with myocarditis-like syndrome during the acute phase of SARS-CoV-2 infection (AMCovS) and post-acute phase (cPACS). METHODS Between September 2020 and January 2022, 39 consecutive patients (24 males, 58%) were referred to our department to perform a CMR for the suspicion of myocarditis related to AMCovS (n = 17) and cPACS (n = 22) at multimodality evaluation (clinical, laboratory, ECG, and echocardiography). CMR was performed for the assessment of volume, function, edema and fibrosis with standard sequences and mapping techniques. CMR diagnosis and the extension and amount of CMR alterations were recorded. RESULTS Patients with suspected myocarditis in acute and post-COVID settings were mainly men (10 (59%) and 12 (54.5%), respectively) with older age in AMCovS (58 [48-64]) compared to cPACS (38 [26-53]). Myocarditis was confirmed by CMR in most of cases: 53% of AMCovS and 50% of cPACS with negligible LGE burden (3 [IQR, 1-5] % and 2 [IQR, 1-4] %, respectively). Myocardial infarction was identified in 4/17 (24%) patients with AMCovS. Cardiomyopathies were identified in 12% (3/17) and 27% (6/22) of patients with AMCovS and cPACS, including DCM, HCM and mitral valve prolapse. CONCLUSIONS In patients with acute and post-acute COVID-19 related suspected myocarditis, CMR improves diagnostic accuracy characterizing ischemic and non-ischemic injury and unraveling subclinical cardiomyopathies.
Collapse
Affiliation(s)
- Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
| | - Elisa Bruno
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
| | - Giovanni Peretto
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
- Department of Cardiac Electrophysiology and ArrhythmologyIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Giacomo De Luca
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
- Unit of Immunology, Rheumatology, Allergy and Rare diseasesIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Corrado Campochiaro
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
- Unit of Immunology, Rheumatology, Allergy and Rare diseasesIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alessandro Tomelleri
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
- Unit of Immunology, Rheumatology, Allergy and Rare diseasesIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Eustachio Agricola
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
- Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Matteo Montorfano
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
- Interventional Cardiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanItaly
| |
Collapse
|
10
|
Chamtouri I, Kaddoussi R, Abroug H, Abdelaaly M, Lassoued T, Fahem N, Cheikh'Hmad S, Ben Abdallah A, Jomaa W, Ben Hamda K, Maatouk F. Mid-term subclinical myocardial injury detection in patients who recovered from COVID-19 according to pulmonary lesion severity. Front Cardiovasc Med 2022; 9:950334. [DOI: 10.3389/fcvm.2022.950334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV 2) may cause damage to the cardiovascular system during the acute phase of the infection. However, recent studies reported mid- to long-term subtle cardiac injuries after recovering from acute coronavirus disease 2019 (COVID-19). This study aimed to determine the relationship between the severity of chest computed tomography (CT) lesions and the persistence of subtle myocardial injuries at mid-term follow-up of patients who recovered from COVID-19 infection.MethodsAll patients with COVID-19 were enrolled prospectively in this study. Sensitive troponin T (hsTnT) and chest CT scans were performed on all patients during the acute phase of COVID-19 infection. At the mid-term follow-up, conventional transthoracic echocardiograph and global longitudinal strain (GLS) of the left and right ventricles (LV and RV) were determined and compared between patients with chest CT scan lesions of < 50% (Group 1) and those with severe chest CT scan lesions of greater or equal to 50% (Group 2).ResultsThe mean age was 55 ± 14 years. Both LV GLS and RV GLS values were significantly decreased in group 2 (p = 0.013 and p = 0.011, respectively). LV GLS value of more than −18 was noted in 43% of all the patients, and an RV GLS value of more than −20 was observed in 48% of them. The group with severe chest CT scan lesions included more patients with reduced LV GLS and reduced RV GLS than the group with mild chest CT scan lesions [(G1:29 vs. G2:57%, p = 0.002) and (G1:36 vs. G2:60 %, p = 0.009), respectively].ConclusionPatients with severe chest CT scan lesions are more likely to develop subclinical myocardial damage. Transthoracic echocardiography (TTE) could be recommended in patients recovering from COVID-19 to detect subtle LV and RV lesions.
Collapse
|
11
|
Beyls C, Martin N, Booz T, Viart C, Boisgard S, Daumin C, Crombet M, Epailly J, Huette P, Dupont H, Abou-Arab O, Mahjoub Y. Prognostic value of acute cor pulmonale in COVID-19-related pneumonia: A prospective study. Front Med (Lausanne) 2022; 9:824994. [PMID: 36267616 PMCID: PMC9576859 DOI: 10.3389/fmed.2022.824994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 09/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background It is known that acute cor pulmonale (ACP) worsens the prognosis of non-coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (NC-ARDS). The ACP risk score evaluates the risk of ACP occurrence in mechanically ventilated patients with NC-ARDS. There is less data on the risk factors and prognosis of ACP induced by COVID-19-related pneumonia. Objective The objective of this study was to evaluate the prognostic value of ACP, assessed by transthoracic echocardiography (TTE) and clinical factors associated with ACP in a cohort of patients with COVID-19-related pneumonia. Materials and methods Between February 2020 and June 2021, patients admitted to intensive care unit (ICU) at Amiens University Hospital for COVID-19-related pneumonia were assessed by TTE within 48 h of admission. ACP was defined as a right ventricle/left ventricle area ratio of >0.6 associated with septal dyskinesia. The primary outcome was mortality at 30 days. Results Among 146 patients included, 36% (n = 52/156) developed ACP of which 38% (n = 20/52) were non-intubated patients. The classical risk factors of ACP (found in NC-ARDS) such as PaCO2 >48 mmHg, driving pressure >18 mmHg, and PaO2/FiO2 < 150 mmHg were not associated with ACP (all P-values > 0.1). The primary outcome occurred in 32 (22%) patients. More patients died in the ACP group (n = 20/52 (38%) vs. n = 12/94 (13%), P = 0.001). ACP [hazards ratio (HR) = 3.35, 95%CI [1.56–7.18], P = 0.002] and age >65 years (HR = 2.92, 95%CI [1.50–5.66], P = 0.002) were independent risk factors of 30-day mortality. Conclusion ACP was a frequent complication in ICU patients admitted for COVID-19-related pneumonia. The 30-day-mortality was 38% in these patients. In COVID-19-related pneumonia, the classical risk factors of ACP did not seem relevant. These results need confirmation in further studies.
Collapse
Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France,UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, Jules Verne University of Picardie, Amiens, France,*Correspondence: Christophe Beyls,
| | - Nicolas Martin
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Thomas Booz
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Christophe Viart
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Solenne Boisgard
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Camille Daumin
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Maxime Crombet
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Julien Epailly
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Pierre Huette
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France,UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, Jules Verne University of Picardie, Amiens, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France,UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, Jules Verne University of Picardie, Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France,UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, Jules Verne University of Picardie, Amiens, France
| |
Collapse
|
12
|
Advanced cardiac imaging in the spectrum of COVID-19 related cardiovascular involvement. Clin Imaging 2022; 90:78-89. [PMID: 35930942 PMCID: PMC9335398 DOI: 10.1016/j.clinimag.2022.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
Cardiovascular involvement is a common complication of COVID-19 infection and is associated to increased risk of unfavorable outcome. Advanced imaging modalities (coronary CT angiography and Cardiac Magnetic Resonance) play a crucial role in the diagnosis, follow-up and risk stratification of patients affected by COVID-19 pneumonia with suspected cardiovascular involvement. In the present manuscript we firstly review current knowledge on the mechanisms by which SARS-CoV-2 can trigger endothelial and myocardial damage. Secondly, the implications of the cardiovascular damage on patient's prognosis are presented. Finally, we provide an overview of the main findings at advanced cardiac imaging characterizing COVID-19 in the acute setting, in the post-acute syndrome, and after vaccination, emphasizing the potentiality of CT and CMR, the indication and their clinical implications.
Collapse
|
13
|
Beyls C, Ghesquières T, Hermida A, Booz T, Crombet M, Martin N, Huette P, Jounieaux V, Dupont H, Abou-Arab O, Mahjoub Y. Feasibility, Prediction and Association of Right Ventricular Free Wall Longitudinal Strain with 30-Day Mortality in Severe COVID-19 Pneumonia: A Prospective Study. J Clin Med 2022; 11:jcm11133629. [PMID: 35806914 PMCID: PMC9267479 DOI: 10.3390/jcm11133629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Right ventricular (RV) systolic dysfunction (RVsD) is a common complication of coronavirus infection 2019 disease (COVID-19). The right ventricular free wall longitudinal strain parameter (RV-FWLS) is a powerful predictor of mortality. We explored the performance of RVsD parameters for predicting 30-day mortality and the association between RV-FWLS and 30-day mortality. Methods: COVID-19 patients hospitalized at Amiens University Hospital in the critical care unit with transthoracic echocardiography were included. We measured tricuspid annular plane systolic excursion (TAPSE), the RV S’ wave, RV fractional area change (RV-FAC), and RV-FWLS. The diagnostic performance of RVsD parameters as predictors for 30-day mortality was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). RVsD was defined by an RV-FWLS < 21% to explore the association between RVsD and 30-day mortality. Results: Of the 116 patients included, 20% (n = 23/116) died and 47 had a RVsD. ROC curve analysis showed that RV-FWLS failed to predict 30-day mortality, as did conventional RV parameters (all p > 0.05). TAPSE (21 (19−26) mm vs. 24 (21−27) mm; p = 0.024) and RV-FAC (40 (35−47)% vs. 47 (41−55)%; p = 0.006) were lowered in the RVsD group. In Cox analysis, RVsD was not associated with 30-day mortality (hazard ratio = 1.12, CI 95% (0.49−2.55), p = 0.78). Conclusion: In severe COVID-19 pneumonia, RV-FWLS was not associated with 30-day mortality.
Collapse
Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
- UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80000 Amiens, France
- Correspondence:
| | - Tristan Ghesquières
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
| | - Alexis Hermida
- Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (A.H.); (N.M.)
| | - Thomas Booz
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
| | - Maxime Crombet
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
| | - Nicolas Martin
- Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (A.H.); (N.M.)
| | - Pierre Huette
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
- UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80000 Amiens, France
| | - Vincent Jounieaux
- Respiratory Department, Amiens University Hospital, F-80054 Amiens, France;
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
- UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80000 Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (T.G.); (T.B.); (M.C.); (P.H.); (H.D.); (O.A.-A.); (Y.M.)
- UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80000 Amiens, France
| |
Collapse
|
14
|
Kimura BJ, Mansour CM. The RVEIO and RV function: More, please. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:14-16. [PMID: 35043438 DOI: 10.1002/jcu.23078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 06/14/2023]
Abstract
Early proof of the value of RVEIO is currently limited by acquisition biases in specific patient populations. More research is needed on this potentially important index.
Collapse
Affiliation(s)
- Bruce J Kimura
- Department of Medicine, Scripps Mercy Hospital, San Diego, California, USA
| | | |
Collapse
|
15
|
Martin AK, Feinman JW, Bhatt HV, Subramani S, Malhotra AK, Townsley MM, Fritz AV, Sharma A, Patel SJ, Zhou EY, Owen RM, Ghofaily LA, Read SN, Teixeira MT, Arora L, Jayaraman AL, Weiner MM, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2021. J Cardiothorac Vasc Anesth 2021; 36:940-951. [PMID: 34801393 DOI: 10.1053/j.jvca.2021.10.011] [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] [Received: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022]
Abstract
This special article is the fourteenth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the Editor-in-Chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series; namely, the research highlights of the past year in the specialty of cardiothoracic and vascular anesthesiology. The major themes selected for 2021 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights in the specialty for 2021 begin with an update on structural heart disease, with a focus on updates in arrhythmia and aortic valve disorders. The second major theme is an update on coronary artery disease, with discussion of both medical and procedural management. The third major theme is focused on the perioperative management of patients with COVID-19, with the authors highlighting literature discussing the impact of the disease on the right ventricle and thromboembolic events. The fourth and final theme is an update in heart failure, with discussion of diverse aspects of this area. The themes selected for this fourteenth special article are only a few of the diverse advances in the specialty during 2021. These highlights will inform the reader of key updates on a variety of topics, leading to improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.
Collapse
Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anita K Malhotra
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Saumil J Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Y Zhou
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert M Owen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lourdes Al Ghofaily
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Selina N Read
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Miguel T Teixeira
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Lovkesh Arora
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Arun L Jayaraman
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
16
|
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
|