Right Ventricular Dysfunction Patterns among Patients with COVID-19 in the Intensive Care Unit: A Retrospective Cohort Analysis.

IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM
Pablo A Sanchez, Christian T O'Donnell, Nadia Francisco, Everton J Santana, Andrew R Moore, Ana Pacheco-Navarro, Jonasel Roque, Katherine M Lebold, Caitlin M Parmer-Chow, Shaun M Pienkos, Bettia E Celestin, Joseph E Levitt, William J Collins, Michael J Lanspa, Euan A Ashley, Jennifer G Wilson, Francois Haddad, Angela J Rogers
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Abstract

Rationale: Right ventricular (RV) dysfunction is common among patients hospitalized with coronavirus disease (COVID-19); however, its epidemiology may depend on the echocardiographic parameters used to define it. Objectives: To evaluate the prevalence of abnormalities in three common echocardiographic parameters of RV function among patients with COVID-19 admitted to the intensive care unit (ICU), as well as the effect of RV dilatation on differential parameter abnormality and the association of RV dysfunction with 60-day mortality. Methods: We conducted a retrospective cohort study of ICU patients with COVID-19 between March 4, 2020, and March 4, 2021, who received a transthoracic echocardiogram within 48 hours before to at most 7 days after ICU admission. RV dysfunction and dilatation, respectively, were defined by guideline thresholds for tricuspid annular plane systolic excursion (TAPSE), RV fractional area change, RV free wall longitudinal strain (RVFWS), and RV basal dimension or RV end-diastolic area. Association of RV dysfunction with 60-day mortality was assessed through logistic regression adjusting for age, prior history of congestive heart failure, invasive ventilation at the time of transthoracic echocardiogram, and Acute Physiology and Chronic Health Evaluation II score. Results: A total of 116 patients were included, of whom 69% had RV dysfunction by one or more parameters, and 36.3% of these had RV dilatation. The three most common patterns of RV dysfunction were the presence of three abnormalities, the combination of abnormal RVFWS and TAPSE, and isolated TAPSE abnormality. Patients with RV dilatation had worse RV fractional area change (24% vs. 36%; P = 0.001), worse RVFWS (16.3% vs. 19.1%; P = 0.005), higher RV systolic pressure (45 mm Hg vs. 31 mm Hg; P = 0.001) but similar TAPSE (13 mm vs. 13 mm; P = 0.30) compared with those with normal RV size. After multivariable adjustment, 60-day mortality was significantly associated with RV dysfunction (odds ratio, 2.91; 95% confidence interval, 1.01-9.44), as was the presence of at least two parameter abnormalities. Conclusions: ICU patients with COVID-19 had significant heterogeneity in RV function abnormalities present with different patterns associated with RV dilatation. RV dysfunction by any parameter was associated with increased mortality. Therefore, a multiparameter evaluation may be critical in recognizing RV dysfunction in COVID-19.

Abstract Image

Abstract Image

重症监护病房新冠肺炎患者右心室功能障碍模式:回顾性队列分析。
理由:右心室(RV)功能障碍在因冠状病毒疾病(新冠肺炎)住院的患者中很常见;然而,其流行病学可能取决于用于定义它的超声心动图参数。目的:评估入住重症监护室(ICU)的新冠肺炎患者中RV功能三种常见超声心动图指标异常的发生率,以及RV扩张对微分参数异常的影响以及RV功能障碍与60天死亡率的关系。方法:我们对2020年3月4日至2021年3月3日期间接受经胸超声心动图检查的新冠肺炎ICU患者进行了回顾性队列研究 小时之前至最多7 ICU入院后几天。右心室功能障碍和扩张分别由三尖瓣环平面收缩偏移(TAPSE)、右心室部分面积变化、右心室游离壁纵向应变(RVFWS)和右心室基础尺寸或右心室舒张末期面积的指导阈值定义。通过调整年龄、充血性心力衰竭病史、经胸超声心动图检查时的有创通气以及急性生理学和慢性健康评估II评分的逻辑回归,评估RV功能障碍与60天死亡率的相关性。结果:共纳入116名患者,其中69%的患者因一个或多个参数而出现RV功能障碍,其中36.3%的患者出现RV扩张。RV功能障碍的三种最常见模式是存在三种异常,即RVFWS和TAPSE异常的组合,以及孤立的TAPSE异常。RV扩张患者的RV部分面积变化更差(24%对36%;P = 0.001),RVFWS较差(16.3%对19.1%;P = 0.005),右心室收缩压更高(45 毫米 汞柱与31 毫米 汞;P = 0.001),但TAPSE相似(13 mm与13 mm;P = 0.30)。多变量校正后,60天死亡率与RV功能障碍显著相关(比值比为2.91;95%置信区间为1.01-9.44),至少存在两个参数异常也是如此。结论:新冠肺炎ICU患者的RV功能异常具有显著的异质性,表现为与RV扩张相关的不同模式。任何参数的RV功能障碍都与死亡率增加有关。因此,多参数评估对于识别新冠肺炎中的RV功能障碍可能至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of the American Thoracic Society
Annals of the American Thoracic Society Medicine-Pulmonary and Respiratory Medicine
CiteScore
9.30
自引率
3.60%
发文量
0
期刊介绍: The Annals of the American Thoracic Society (AnnalsATS) is the official international online journal of the American Thoracic Society. Formerly known as PATS, it provides comprehensive and authoritative coverage of a wide range of topics in adult and pediatric pulmonary medicine, respiratory sleep medicine, and adult medical critical care. As a leading journal in its field, AnnalsATS offers up-to-date and reliable information that is directly applicable to clinical practice. It serves as a valuable resource for clinical specialists, supporting their formative and continuing education. Additionally, the journal is committed to promoting public health by publishing research and articles that contribute to the advancement of knowledge in these fields.
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