Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up
Abstract Purpose Patients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay. Methods Prospective and bice...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-01-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-024-01248-8 |
| _version_ | 1797276263510966272 |
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| author | Mathieu Jozwiak Claire Dupuis Pierre Denormandie Didac Aurenche Mateu Jean Louchet Nathan Heme Jean-Paul Mira Denis Doyen Jean Dellamonica |
| author_facet | Mathieu Jozwiak Claire Dupuis Pierre Denormandie Didac Aurenche Mateu Jean Louchet Nathan Heme Jean-Paul Mira Denis Doyen Jean Dellamonica |
| author_sort | Mathieu Jozwiak |
| collection | DOAJ |
| description | Abstract Purpose Patients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay. Methods Prospective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days. The different patterns of RV injury were isolated RV dilation, RV dysfunction (tricuspid annular plane systolic excursion < 17 mm and/or systolic tricuspid annular velocity < 9.5 cm/s and/or RV fractional area change < 35%) without RV dilation, RV dysfunction with RV dilation and acute cor pulmonale (ACP, RV dilatation with paradoxical septal motion). The different RV injury patterns were described and their association with Day-28 mortality was investigated. Results Of 118 patients with complete echocardiographic follow-up who underwent 393 TTE examinations during ICU stay, 73(62%) had at least one RV injury pattern during one or several TTE examinations: 29(40%) had isolated RV dilation, 39(53%) had RV dysfunction without RV dilation, 10(14%) had RV dysfunction with RV dilation and 2(3%) had ACP. Patients with RV injury were more likely to have cardiovascular risk factors, to be intubated and to receive norepinephrine and had a higher Day-28 mortality rate (27 vs. 7%, p < 0.01). RV injury was isolated in 82% of cases, combined with left ventricular systolic dysfunction in 18% of cases and 10% of patients with RV injury experienced several patterns of RV injury during ICU stay. The number of patients with de novo RV injury decreased over time, no patient developed de novo RV injury after Day-14 regardless of the RV injury pattern and 20(31%) patients without RV injury on ICU admission developed RV injury during ICU stay. Only the combination of RV dysfunction with RV dilation or ACP (aHR = 3.18 95% CI(1.16–8.74), p = 0.03) was associated with Day-28 mortality. Conclusion RV injury was frequent in COVID-19 patients, occurred within the first two weeks after ICU admission and was most often isolated. Only the combination of RV dysfunction with RV dilation or ACP could potentially be associated with Day-28 mortality. Clinical trial registration NCT04335162. |
| first_indexed | 2024-03-07T15:25:44Z |
| format | Article |
| id | doaj.art-6c0190300cea4d02a75d9b00dfc028f5 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-03-07T15:25:44Z |
| publishDate | 2024-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-6c0190300cea4d02a75d9b00dfc028f52024-03-05T16:43:07ZengSpringerOpenAnnals of Intensive Care2110-58202024-01-0114111310.1186/s13613-024-01248-8Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-upMathieu Jozwiak0Claire Dupuis1Pierre Denormandie2Didac Aurenche Mateu3Jean Louchet4Nathan Heme5Jean-Paul Mira6Denis Doyen7Jean Dellamonica8Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique–Hôpitaux de ParisService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel MontpiedService de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique–Hôpitaux de ParisService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de NiceService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de NiceService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de NiceService de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique–Hôpitaux de ParisUR2CA-Unité de Recherche Clinique Côte d’Azur, Université Côte d’AzurUR2CA-Unité de Recherche Clinique Côte d’Azur, Université Côte d’AzurAbstract Purpose Patients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay. Methods Prospective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days. The different patterns of RV injury were isolated RV dilation, RV dysfunction (tricuspid annular plane systolic excursion < 17 mm and/or systolic tricuspid annular velocity < 9.5 cm/s and/or RV fractional area change < 35%) without RV dilation, RV dysfunction with RV dilation and acute cor pulmonale (ACP, RV dilatation with paradoxical septal motion). The different RV injury patterns were described and their association with Day-28 mortality was investigated. Results Of 118 patients with complete echocardiographic follow-up who underwent 393 TTE examinations during ICU stay, 73(62%) had at least one RV injury pattern during one or several TTE examinations: 29(40%) had isolated RV dilation, 39(53%) had RV dysfunction without RV dilation, 10(14%) had RV dysfunction with RV dilation and 2(3%) had ACP. Patients with RV injury were more likely to have cardiovascular risk factors, to be intubated and to receive norepinephrine and had a higher Day-28 mortality rate (27 vs. 7%, p < 0.01). RV injury was isolated in 82% of cases, combined with left ventricular systolic dysfunction in 18% of cases and 10% of patients with RV injury experienced several patterns of RV injury during ICU stay. The number of patients with de novo RV injury decreased over time, no patient developed de novo RV injury after Day-14 regardless of the RV injury pattern and 20(31%) patients without RV injury on ICU admission developed RV injury during ICU stay. Only the combination of RV dysfunction with RV dilation or ACP (aHR = 3.18 95% CI(1.16–8.74), p = 0.03) was associated with Day-28 mortality. Conclusion RV injury was frequent in COVID-19 patients, occurred within the first two weeks after ICU admission and was most often isolated. Only the combination of RV dysfunction with RV dilation or ACP could potentially be associated with Day-28 mortality. Clinical trial registration NCT04335162.https://doi.org/10.1186/s13613-024-01248-8Acute respiratory distress syndromeCOVID-19Cardiac injuryRight ventriclePrognosis |
| spellingShingle | Mathieu Jozwiak Claire Dupuis Pierre Denormandie Didac Aurenche Mateu Jean Louchet Nathan Heme Jean-Paul Mira Denis Doyen Jean Dellamonica Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up Annals of Intensive Care Acute respiratory distress syndrome COVID-19 Cardiac injury Right ventricle Prognosis |
| title | Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up |
| title_full | Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up |
| title_fullStr | Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up |
| title_full_unstemmed | Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up |
| title_short | Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up |
| title_sort | right ventricular injury in critically ill patients with covid 19 a descriptive study with standardized echocardiographic follow up |
| topic | Acute respiratory distress syndrome COVID-19 Cardiac injury Right ventricle Prognosis |
| url | https://doi.org/10.1186/s13613-024-01248-8 |
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