Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS
AIM: To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute Respiratory Distress Syndrome (ARDS).
METHODS: Ninety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio RESULTS: The majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270 ± 104 vs. 117 ± 57 mmHg, p < 0.001). In the non-survivors, PASP was increased (42 ± 12 vs. 30 ± 7 mmHg, p < 0.001), while TAPSE was decreased (19 ± 4 vs. 25 ± 4 mm, p < 0.001). Accordingly, the TAPSE/PASP ratio was lower than in the survivors (0.51 ± 0.22 vs. 0.89 ± 0.29 mm/mmHg, p < 0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR: 0.026; 95%CI 0.01-0.579; p: 0.019) and PaO2/FIO2 (HR: 0.988; 95%CI 0.988-0.998; p: 0.018) ratios were the only independent predictors of mortality, with ROC-determined cutoff values of 159 mmHg and 0.635 mm/mmHg, respectively.
CONCLUSIONS: COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Critical care (London, England) - 24(2020), 1 vom: 30. Nov., Seite 670 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
D'Alto, Michele [VerfasserIn] |
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| Links: |
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| Themen: |
ARDS |
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| Anmerkungen: |
Date Completed 11.12.2020 Date Revised 30.03.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13054-020-03385-5 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318231719 |
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| 100 | 1 | |a D'Alto, Michele |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 11.12.2020 | ||
| 500 | |a Date Revised 30.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a AIM: To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute Respiratory Distress Syndrome (ARDS) | ||
| 520 | |a METHODS: Ninety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio RESULTS: The majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270 ± 104 vs. 117 ± 57 mmHg, p < 0.001). In the non-survivors, PASP was increased (42 ± 12 vs. 30 ± 7 mmHg, p < 0.001), while TAPSE was decreased (19 ± 4 vs. 25 ± 4 mm, p < 0.001). Accordingly, the TAPSE/PASP ratio was lower than in the survivors (0.51 ± 0.22 vs. 0.89 ± 0.29 mm/mmHg, p < 0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR: 0.026; 95%CI 0.01-0.579; p: 0.019) and PaO2/FIO2 (HR: 0.988; 95%CI 0.988-0.998; p: 0.018) ratios were the only independent predictors of mortality, with ROC-determined cutoff values of 159 mmHg and 0.635 mm/mmHg, respectively | ||
| 520 | |a CONCLUSIONS: COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a ARDS | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Echocardiography | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Right ventricular-arterial uncoupling | |
| 700 | 1 | |a Marra, Alberto M |e verfasserin |4 aut | |
| 700 | 1 | |a Severino, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Salzano, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Romeo, Emanuele |e verfasserin |4 aut | |
| 700 | 1 | |a De Rosa, Rosanna |e verfasserin |4 aut | |
| 700 | 1 | |a Stagnaro, Francesca Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Pagnano, Gianpiero |e verfasserin |4 aut | |
| 700 | 1 | |a Verde, Raffaele |e verfasserin |4 aut | |
| 700 | 1 | |a Murino, Patrizia |e verfasserin |4 aut | |
| 700 | 1 | |a Farro, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Ciccarelli, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Vargas, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Fiorentino, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Servillo, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Gentile, Ivan |e verfasserin |4 aut | |
| 700 | 1 | |a Corcione, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Cittadini, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Naeije, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Golino, Paolo |e verfasserin |4 aut | |
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