tetano
Editor, Senior Moderator
CJC Open
. 2020 Sep 20.
doi: 10.1016/j.cjco.2020.09.016. Online ahead of print.
Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized with COVID-19 according to Race
William E Moody[SUP] 1 [/SUP], Hani M Mahmoud-Elsayed[SUP] 1 [/SUP], Jonathan Senior[SUP] 1 [/SUP], Uzma Gul[SUP] 2 [/SUP], Ayisha M Khan-Kheil[SUP] 1 [/SUP], Sebastian Horne[SUP] 2 [/SUP], Amitava Banerjee[SUP] 3 [/SUP], William M Bradlow[SUP] 1 [/SUP], Robert Huggett[SUP] 2 [/SUP], Sandeep S Hothi[SUP] 4 [/SUP], Muhammad Shahid[SUP] 2 [/SUP], Richard P Steeds[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Epidemiological studies suggest that black, Asian and minority ethnic (BAME) patients may be at risk of worse outcomes from Coronavirus-19 (COVID-19) but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality and race in COVID-19 pneumonia.
Methods: This was a multicenter, retrospective, observational study including 164 adults (61?13years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (IQR 2 - 5) from admission. The primary outcome was all-cause mortality.
Results: After a median follow up of 31 days (IQR 14 - 42 days), 58 (35%) patients had died. The right ventricle (RV) was dilated in 62 (38%) patients, and 58 (35%) patients had RV systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = -0.18, p = 0.025) and high-sensitivity cardiac Troponin (ρ = -0.30, p < 0.0001). Reduced RV systolic function (HR, 1.80; 95% CI, 1.05 - 3.09; p = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers or mortality.
Conclusions: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is however, no racial variation in the early findings on echocardiography, biomarkers or mortality.
Keywords: COVID-19; Cardiac Biomarkers; Doppler Echocardiography; Ethnicity; Right Ventricle.
. 2020 Sep 20.
doi: 10.1016/j.cjco.2020.09.016. Online ahead of print.
Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized with COVID-19 according to Race
William E Moody[SUP] 1 [/SUP], Hani M Mahmoud-Elsayed[SUP] 1 [/SUP], Jonathan Senior[SUP] 1 [/SUP], Uzma Gul[SUP] 2 [/SUP], Ayisha M Khan-Kheil[SUP] 1 [/SUP], Sebastian Horne[SUP] 2 [/SUP], Amitava Banerjee[SUP] 3 [/SUP], William M Bradlow[SUP] 1 [/SUP], Robert Huggett[SUP] 2 [/SUP], Sandeep S Hothi[SUP] 4 [/SUP], Muhammad Shahid[SUP] 2 [/SUP], Richard P Steeds[SUP] 1 [/SUP]
Affiliations
- PMID: 32984798
- PMCID: PMC7502228
- DOI: 10.1016/j.cjco.2020.09.016
Abstract
Background: Epidemiological studies suggest that black, Asian and minority ethnic (BAME) patients may be at risk of worse outcomes from Coronavirus-19 (COVID-19) but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality and race in COVID-19 pneumonia.
Methods: This was a multicenter, retrospective, observational study including 164 adults (61?13years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (IQR 2 - 5) from admission. The primary outcome was all-cause mortality.
Results: After a median follow up of 31 days (IQR 14 - 42 days), 58 (35%) patients had died. The right ventricle (RV) was dilated in 62 (38%) patients, and 58 (35%) patients had RV systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = -0.18, p = 0.025) and high-sensitivity cardiac Troponin (ρ = -0.30, p < 0.0001). Reduced RV systolic function (HR, 1.80; 95% CI, 1.05 - 3.09; p = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers or mortality.
Conclusions: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is however, no racial variation in the early findings on echocardiography, biomarkers or mortality.
Keywords: COVID-19; Cardiac Biomarkers; Doppler Echocardiography; Ethnicity; Right Ventricle.