tetano
Editor, Senior Moderator
J Cardiothorac Vasc Anesth
. 2021 Apr 11;S1053-0770(21)00333-5.
doi: 10.1053/j.jvca.2021.04.008. Online ahead of print.
Right Ventricular Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis
Gianluca Paternoster[SUP] 1 [/SUP], Pietro Bertini[SUP] 2 [/SUP], Pasquale Innelli[SUP] 3 [/SUP], Paolo Trambaiolo[SUP] 4 [/SUP], Giovanni Landoni[SUP] 5 [/SUP], Federico Franchi[SUP] 6 [/SUP], Sabino Scolletta[SUP] 6 [/SUP], Fabio Guarracino[SUP] 2 [/SUP]
Affiliations
Abstract
Objective: This systematic review and meta-analysis aimed to describe the features of right ventricular impairment and pulmonary hypertension in coronavirus disease (COVID-19) and assess their effect on mortality.
Design: The authors carried out a systematic review and meta-analysis of observational studies.
Setting: The authors performed a search through PubMed, the International Clinical Trials Registry Platform, and the Cochrane Library for studies reporting right ventricular dysfunction in patients with COVID-19 and outcomes.
Participants: The search yielded nine studies in which the appropriate data were available.
Interventions: Pooled odds ratios were calculated according to the random-effects model.
Measurements and main results: Overall, 1,450 patients were analyzed, and half of them were invasively ventilated. Primary outcome was mortality at the longest follow-up available. Mortality was 48.5% versus 24.7% in patients with or without right ventricular impairment (n = 7; OR = 3.10; 95% confidence interval [CI] 1.72-5.58; p = 0.0002), 56.3% versus 30.6% in patients with or without right ventricular dilatation (n = 6; OR = 2.43; 95% CI 1.41-4.18; p = 0.001), and 52.9% versus 14.8% in patients with or without pulmonary hypertension (n = 3; OR = 5.75; 95% CI 2.67-12.38; p < 0.001).
Conclusion: Mortality in patients with COVID-19 requiring respiratory support and with a diagnosis of right ventricular dysfunction, dilatation, or pulmonary hypertension is high. Future studies should highlight the mechanisms of right ventricular derangement in COVID-19, and early detection of right ventricular impairment using ultrasound might be important to individualize therapies and improve outcomes.
Keywords: ARDS; COVID-19; critical care; echocardiography; meta-analysis; right ventricle.
. 2021 Apr 11;S1053-0770(21)00333-5.
doi: 10.1053/j.jvca.2021.04.008. Online ahead of print.
Right Ventricular Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis
Gianluca Paternoster[SUP] 1 [/SUP], Pietro Bertini[SUP] 2 [/SUP], Pasquale Innelli[SUP] 3 [/SUP], Paolo Trambaiolo[SUP] 4 [/SUP], Giovanni Landoni[SUP] 5 [/SUP], Federico Franchi[SUP] 6 [/SUP], Sabino Scolletta[SUP] 6 [/SUP], Fabio Guarracino[SUP] 2 [/SUP]
Affiliations
- PMID: 33980426
- DOI: 10.1053/j.jvca.2021.04.008
Abstract
Objective: This systematic review and meta-analysis aimed to describe the features of right ventricular impairment and pulmonary hypertension in coronavirus disease (COVID-19) and assess their effect on mortality.
Design: The authors carried out a systematic review and meta-analysis of observational studies.
Setting: The authors performed a search through PubMed, the International Clinical Trials Registry Platform, and the Cochrane Library for studies reporting right ventricular dysfunction in patients with COVID-19 and outcomes.
Participants: The search yielded nine studies in which the appropriate data were available.
Interventions: Pooled odds ratios were calculated according to the random-effects model.
Measurements and main results: Overall, 1,450 patients were analyzed, and half of them were invasively ventilated. Primary outcome was mortality at the longest follow-up available. Mortality was 48.5% versus 24.7% in patients with or without right ventricular impairment (n = 7; OR = 3.10; 95% confidence interval [CI] 1.72-5.58; p = 0.0002), 56.3% versus 30.6% in patients with or without right ventricular dilatation (n = 6; OR = 2.43; 95% CI 1.41-4.18; p = 0.001), and 52.9% versus 14.8% in patients with or without pulmonary hypertension (n = 3; OR = 5.75; 95% CI 2.67-12.38; p < 0.001).
Conclusion: Mortality in patients with COVID-19 requiring respiratory support and with a diagnosis of right ventricular dysfunction, dilatation, or pulmonary hypertension is high. Future studies should highlight the mechanisms of right ventricular derangement in COVID-19, and early detection of right ventricular impairment using ultrasound might be important to individualize therapies and improve outcomes.
Keywords: ARDS; COVID-19; critical care; echocardiography; meta-analysis; right ventricle.