tetano
Editor, Senior Moderator
Intensive Care Med
. 2023 Jul 12.
doi: 10.1007/s00134-023-07147-z. Online ahead of print. Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study
Stephen Huang[SUP] 1 [/SUP], Antoine Vieillard-Baron[SUP] 2 3 [/SUP], Bruno Evrard[SUP] 4 [/SUP], Gwenaël Prat[SUP] 5 [/SUP], Michelle S Chew[SUP] 6 [/SUP], Martin Balik[SUP] 7 [/SUP], Fernando Clau-Terré[SUP] 8 [/SUP], Daniel De Backer[SUP] 9 [/SUP], Armand Mekontso Dessap[SUP] 10 [/SUP], Sam Orde[SUP] 1 [/SUP], Andrea Morelli[SUP] 11 [/SUP], Filippo Sanfilippo[SUP] 12 [/SUP], Cyril Charron[SUP] 2 3 [/SUP], Philippe Vignon[SUP] 13 14 [/SUP]; ECHO-COVID study group
Collaborators, Affiliations
Purpose: Exploratory study to evaluate the association of different phenotypes of right ventricular (RV) involvement and mortality in the intensive care unit (ICU) in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19).
Methods: Post-hoc analysis of longitudinal data from the multicenter ECHO-COVID observational study in ICU patients who underwent at least two echocardiography examinations. Echocardiography phenotypes were acute cor pulmonale (ACP, RV cavity dilatation with paradoxical septal motion), RV failure (RVF, RV cavity dilatation and systemic venous congestion), and RV dysfunction (tricuspid annular plane systolic excursion ≤ 16 mm). Accelerated failure time model and multistate model were used for analysis.
Results: Of 281 patients who underwent 948 echocardiography studies during ICU stay, 189 (67%) were found to have at least 1 type of RV involvements during one or several examinations: ACP (105/281, 37.4%), RVF (140/256, 54.7%) and/or RV dysfunction (74/255, 29%). Patients with all examinations displaying ACP had survival time shortened by 0.479 [0.284-0.803] times when compared to patients with all examinations depicting no ACP (P = 0.005). RVF showed a trend towards shortened survival time by a factor of 0.642 [0.405-1.018] (P = 0.059), whereas the impact of RV dysfunction on survival time was inconclusive (P = 0.451). Multistate analysis showed that patients might transit in and out of RV involvement, and those who exhibited ACP in their last critical care echocardiography (CCE) examination had the highest risk of mortality (hazard ratio (HR) 3.25 [2.38-4.45], P < 0.001).
Conclusion: RV involvement is prevalent in patients ventilated for COVID-19 ARDS. Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.
Trial registration: ClinicalTrials.gov NCT04414410.
Keywords: ARDS; COVID-19; Cor pulmonale; Mortality; Right ventricular dysfunction
. 2023 Jul 12.
doi: 10.1007/s00134-023-07147-z. Online ahead of print. Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study
Stephen Huang[SUP] 1 [/SUP], Antoine Vieillard-Baron[SUP] 2 3 [/SUP], Bruno Evrard[SUP] 4 [/SUP], Gwenaël Prat[SUP] 5 [/SUP], Michelle S Chew[SUP] 6 [/SUP], Martin Balik[SUP] 7 [/SUP], Fernando Clau-Terré[SUP] 8 [/SUP], Daniel De Backer[SUP] 9 [/SUP], Armand Mekontso Dessap[SUP] 10 [/SUP], Sam Orde[SUP] 1 [/SUP], Andrea Morelli[SUP] 11 [/SUP], Filippo Sanfilippo[SUP] 12 [/SUP], Cyril Charron[SUP] 2 3 [/SUP], Philippe Vignon[SUP] 13 14 [/SUP]; ECHO-COVID study group
Collaborators, Affiliations
- PMID: 37436445
- DOI: 10.1007/s00134-023-07147-z
Purpose: Exploratory study to evaluate the association of different phenotypes of right ventricular (RV) involvement and mortality in the intensive care unit (ICU) in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19).
Methods: Post-hoc analysis of longitudinal data from the multicenter ECHO-COVID observational study in ICU patients who underwent at least two echocardiography examinations. Echocardiography phenotypes were acute cor pulmonale (ACP, RV cavity dilatation with paradoxical septal motion), RV failure (RVF, RV cavity dilatation and systemic venous congestion), and RV dysfunction (tricuspid annular plane systolic excursion ≤ 16 mm). Accelerated failure time model and multistate model were used for analysis.
Results: Of 281 patients who underwent 948 echocardiography studies during ICU stay, 189 (67%) were found to have at least 1 type of RV involvements during one or several examinations: ACP (105/281, 37.4%), RVF (140/256, 54.7%) and/or RV dysfunction (74/255, 29%). Patients with all examinations displaying ACP had survival time shortened by 0.479 [0.284-0.803] times when compared to patients with all examinations depicting no ACP (P = 0.005). RVF showed a trend towards shortened survival time by a factor of 0.642 [0.405-1.018] (P = 0.059), whereas the impact of RV dysfunction on survival time was inconclusive (P = 0.451). Multistate analysis showed that patients might transit in and out of RV involvement, and those who exhibited ACP in their last critical care echocardiography (CCE) examination had the highest risk of mortality (hazard ratio (HR) 3.25 [2.38-4.45], P < 0.001).
Conclusion: RV involvement is prevalent in patients ventilated for COVID-19 ARDS. Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.
Trial registration: ClinicalTrials.gov NCT04414410.
Keywords: ARDS; COVID-19; Cor pulmonale; Mortality; Right ventricular dysfunction