Right Ventricular Dysfunction in Ventilated Patients with COVID-19 (COVID-RV)

Purpose COVID-19 is associated with cardiovascular complications, with right ventricular dysfunction (RVD) commonly reported. The combination of acute respiratory distress syndrome (ARDS), injurious invasive ventilation, micro/macro thrombi and the potential for direct myocardial injury create conditions where RVD is likely to occur. No study has prospectively explored the prevalence of RVD, and its association with mortality, in a cohort requiring mechanical ventilation. Methods Prospective, multi-centre, trans-thoracic echocardiographic, cohort study of ventilated patients with COVID-19 in Scottish intensive care units. RVD was defined as the presence of severe RV dilatation and interventricular septal flattening. To explore role of myocardial injury, high sensitivity troponin and N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured in all patients. Results One hundred and twenty-one patients were recruited to COVID-RV, 118 underwent imaging and it was possible to determine the primary outcome in 112. RVD was present in seven (6.2% [95%CI; 2.5%, 12.5%]) patients. Thirty-day mortality was 85.7% in those with RVD, compared to 44.8% in those without (p=0.051). Patients with RVD were more likely to have; pulmonary thromboembolism (p<0.001), higher plateau pressure (p=0.048), lower dynamic compliance (p=0.031), higher NT-proBNP (p<0.006) and more frequent abnormal troponin (p=0.048). Abnormal NT-proBNP (OR 4.77 [1.22, 21.32], p=0.03) and abnormal Troponin (16.54 [4.98, 67.12], p<0.001) independently predicted 30-day mortality. Conclusion COVID-RV demonstrates a prevalence of RVD in ventilated patients with COVID-19 of 6.2% and is associated with a mortality of 85.7%. Association is observed between RVD and each of the aetiological domains of; ARDS, ventilation, micro/macro thrombi and myocardial injury.

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Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

Infection ◽

10.1007/s15010-020-01572-8 ◽

2021 ◽

Author(s):

Stéphanie Bieber ◽

Angelina Kraechan ◽

Johannes C. Hellmuth ◽

Maximilian Muenchhoff ◽

Clemens Scherer ◽

...

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Ventricular Function ◽

Myocardial Injury ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Left Ventricular ◽

Ventricular Ejection Fraction ◽

Strain Echocardiography

Abstract Purpose SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout the pandemic course in 2019, its morphological characterisation is still unclear. With this study, we aimed to characterise echocardiographic patterns of ventricular function in patients with COVID-19-associated myocardial injury. Methods We prospectively assessed 32 patients hospitalised with COVID-19 and presence or absence of elevated high sensitive troponin T (hsTNT+ vs. hsTNT-) by comprehensive three-dimensional (3D) and strain echocardiography. Results A minority (34.3%) of patients had normal ventricular function, whereas 65.7% had left and/or right ventricular dysfunction defined by impaired left and/or right ventricular ejection fraction and strain measurements. Concomitant biventricular dysfunction was common in hsTNT+ patients. We observed impaired left ventricular (LV) global longitudinal strain (GLS) in patients with myocardial injury (-13.9% vs. -17.7% for hsTNT+ vs. hsTNT-, p = 0.005) but preserved LV ejection fraction (52% vs. 59%, p = 0.074). Further, in these patients, right ventricular (RV) systolic function was impaired with lower RV ejection fraction (40% vs. 49%, p = 0.001) and reduced RV free wall strain (-18.5% vs. -28.3%, p = 0.003). Myocardial dysfunction partially recovered in hsTNT + patients after 52 days of follow-up. In particular, LV-GLS and RV-FWS significantly improved from baseline to follow-up (LV-GLS: -13.9% to -16.5%, p = 0.013; RV-FWS: -18.5% to -22.3%, p = 0.037). Conclusion In patients with COVID-19-associated myocardial injury, comprehensive 3D and strain echocardiography revealed LV dysfunction by GLS and RV dysfunction, which partially resolved at 2-month follow-up. Trial registration COVID-19 Registry of the LMU University Hospital Munich (CORKUM), WHO trial ID DRKS00021225.

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Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

International Heart Journal ◽

10.1536/ihj.16-255 ◽

2017 ◽

Vol 58 (2) ◽

pp. 225-231 ◽

Cited By ~ 5

Author(s):

Hidehiro Kaneko ◽

Michael Neuss ◽

Jens Weissenborn ◽

Christian Butter

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Mitral Regurgitation ◽

Right Ventricular ◽

Natriuretic Peptide ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Severe Mitral Regurgitation

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THE RELATIONSHIP OF NT PRO BNP AND ECHOCARDIOGRAPHIC FEATURES OF RIGHT VENTRICLE DISFUNCTION WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT HAJI ADAM MALIK GENERAL HOSPITAL MEDAN

International journal of Research science and Management - September-2020 ◽

10.29121/ijrsm.v7.i12.2020.9 ◽

2020 ◽

Vol 7 (12) ◽

pp. 49-50

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Right Ventricular ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Cardiovascular Complications ◽

Chronic Obstructive ◽

Pathological Findings ◽

Obstructive Pulmonary Disease ◽

The Relationship ◽

Severe Copd

Background: Cardiovascular complications caused by Chronic Obstructive Pulmonary Disease (COPD) will affect structure and function of heart’s normal anatomy. This study aims to determine the relationship between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular (RV) dysfunction in COPD. Method: A cross-sectional study to assess the association between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular dysfunction in COPD in the outpatient unit of the Integrated Heart Center H. Adam Malik Hospital Medan. COPD patients were grouped based on GOLD criteria from spirometry examination into severe COPD (GOLD III) and very severe COPD (GOLD IV). Subjects then performed NT pro BNP and echocardiography examination to assess pathological changes in cardiac. Result: NT Pro BNP was higher in GOLD IV. Cut off value of NT Pro BNP > 172 pg/nl is the initial parameter of right ventricular dysfunction. Pulmonary hypertension was found in 93% of cases. The most common cardiac pathological findings were RV hypertrophy (71%), RV dysfunction (86.7%) and pulmonary regurgitation (87.5%). Pathological findings on echocardiography were more common in the GOLD IV group. COPD severity was associated with NT Pro BNP abnormalities (p <0.001) and associated with pathologic echocardiographic findings (p <0.001). Conclusion: Severe COPD is associated with increased NT pro-BNP abnormalities and pathological findings on echocardiography. Echocardiography facilitates early detection of cardiovascular complications in patients with severe and very severe COPD (GOLD III and IV).

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