Prognostic Utility of Right Ventricular Remodeling Over Conventional Risk Stratification in Patients With COVID-19

Coronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain. The purpose of this study was to test whether adverse RV remodeling (dysfuncti...

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Published in:Journal of the American College of Cardiology Vol. 76; no. 17; p. 1965
Main Authors: Kim, Jiwon, Volodarskiy, Alexander, Sultana, Razia, Pollie, Meridith P, Yum, Brian, Nambiar, Lakshmi, Tafreshi, Romina, Mitlak, Hannah W, RoyChoudhury, Arindam, Horn, Evelyn M, Hriljac, Ingrid, Narula, Nupoor, Kim, Sijun, Ndhlovu, Lishomwa, Goyal, Parag, Safford, Monika M, Shaw, Leslee, Devereux, Richard B, Weinsaft, Jonathan W
Format: Journal Article
Language:English
Published: United States 27.10.2020
Subjects:
Aged
Aged, 80 and over
Betacoronavirus
Biomarkers - blood
Cohort Studies
Coronavirus Infections - blood
Coronavirus Infections - diagnostic imaging
Coronavirus Infections - mortality
Coronavirus Infections - physiopathology
COVID-19
Echocardiography
Female
Heart - diagnostic imaging
Heart - physiopathology
Humans
Male
Middle Aged
New York City - epidemiology
Pandemics
Pneumonia, Viral - blood
Pneumonia, Viral - diagnostic imaging
Pneumonia, Viral - mortality
Pneumonia, Viral - physiopathology
Risk Assessment
SARS-CoV-2
Ventricular Remodeling
New York City
right ventricle
echocardiography
COVID-19 (coronavirus)
ISSN:1558-3597, 1558-3597
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Summary:Coronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain. The purpose of this study was to test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification. Consecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at 3 New York City hospitals were studied; images were analyzed by a central core laboratory blinded to clinical and biomarker data. In total, 510 patients (age 64 ± 14 years, 66% men) were studied; RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p = 0.007). During inpatient follow-up (median 20 days), 77% of patients had a study-related endpoint (death 32%, discharge 45%). RV dysfunction (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.49 to 4.43; p = 0.001) and dilation (HR: 1.43; 95% CI: 1.05 to 1.96; p = 0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR: 1.39; 95% CI: 1.01 to 1.90; p = 0.041). RV indices provided additional risk stratification beyond biomarker strata; risk for death was greatest among patients with adverse RV remodeling and positive biomarkers and was lesser among patients with isolated biomarker elevations (p ≤ 0.001). In multivariate analysis, adverse RV remodeling conferred a >2-fold increase in mortality risk, which remained significant (p < 0.01) when controlling for age and biomarker elevations; the predictive value of adverse RV remodeling was similar irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.
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ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2020.08.066