RV dilation/dysfunction predicts mortality in COVID-19
Adverse right ventricular (RV) remodeling (dysfunction/dilation) is associated with increased mortality risk in patients with the novel coronavirus disease (COVID-19) independent of standard clinical and biomarker risk stratification, according to a study.
The investigators examined consecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at three New York City hospitals. A central core laboratory blinded to clinical and biomarker data analysed the images.
Among 510 patients (mean age, 64 years; 66 percent men) included in the analysis, 35 percent had RV dilation and 15 percent RV dysfunction. A stepwise increase in RV dysfunction was noted with regard to RV chamber size (p=0.007). Seventy-seven percent of patients had a study-related endpoint (death 32 percent; discharge 45 percent) during a median follow-up of 20 days.
RV dysfunction (hazard ratio [HR], 2.57, 95 percent confidence interval [CI], 1.49–4.43; p=0.001) and dilation (HR, 1.43, 95 percent CI, 1.05–1.96; p=0.02) independently correlated with a risk in mortality. Patients without adverse RV remodeling had a higher chance to survive to hospital discharge (HR, 1.39, 95 percent CI, 1.01–1.90; p=0.041).
RV indices provided additional risk stratification beyond biomarker strata. For instance, mortality risk was highest among patients with adverse RV remodeling and positive biomarkers. On the other hand, those with isolated biomarker elevations had a much lower risk (p≤0.001).
In multivariate analysis, adverse RV remodeling correlated with a more than twofold increase in mortality risk. This association persisted (p<0.01) when controlling for age and biomarker elevations. The predictive value of adverse RV remodeling was similar regardless of whether analyses were carried out using troponin, D-dimer, or ferritin, according to the investigators.