Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 10 2021
01 10 2021
Historique:
pubmed:
6
7
2021
medline:
29
9
2021
entrez:
5
7
2021
Statut:
ppublish
Résumé
To assess whether right ventricular dilation or systolic impairment is associated with mortality and/or disease severity in invasively ventilated patients with coronavirus disease 2019 acute respiratory distress syndrome. Retrospective cohort study. Single-center U.K. ICU. Patients with coronavirus disease 2019 acute respiratory distress syndrome undergoing invasive mechanical ventilation that received a transthoracic echocardiogram between March and December 2020. None. Right ventricular dilation was defined as right ventricular:left ventricular end-diastolic area greater than 0.6, right ventricular systolic impairment as fractional area change less than 35%, or tricuspid annular plane systolic excursion less than 17 mm. One hundred seventy-two patients were included, 59 years old (interquartile range, 49-67), with mostly moderate acute respiratory distress syndrome (n = 101; 59%). Ninety-day mortality was 41% (n = 70): 49% in patients with right ventricular dilation, 53% in right ventricular systolic impairment, and 72% in right ventricular dilation with systolic impairment. The right ventricular dilation with systolic impairment phenotype was independently associated with mortality (odds ratio, 3.11 [95% CI, 1.15-7.60]), but either disease state alone was not. Right ventricular fractional area change correlated with Pao2:Fio2 ratio, Paco2, chest radiograph opacification, and dynamic compliance, whereas right ventricular:left ventricle end-diastolic area correlated negatively with urine output. Right ventricular systolic impairment correlated with pulmonary pathophysiology, whereas right ventricular dilation correlated with renal dysfunction. Right ventricular dilation with systolic impairment was the only right ventricular phenotype that was independently associated with mortality.
Identifiants
pubmed: 34224453
doi: 10.1097/CCM.0000000000005167
pii: 00003246-202110000-00015
pmc: PMC8439642
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1757-1768Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Drs. Parekh and Patel received support for article research from Research Councils UK. Dr. Parekh received support for article research from the National Institute for Health Research. Dr. Bangash received funding from the Intensive Care Society. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Mekontso Dessap A, Boissier F, Charron C, et al.: Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: Prevalence, predictors, and clinical impact. Intensive Care Med. 2016; 42:862–870
Zochios V, Parhar K, Tunnicliffe W, et al.: The right ventricle in ARDS. Chest. 2017; 152:181–193
Vieillard-Baron A, Charron C, Caille V, et al.: Prone positioning unloads the right ventricle in severe ARDS. Chest. 2007; 132:1440–1446
Grasselli G, Tonetti T, Protti A, et al.; Collaborators: Pathophysiology of COVID-19-associated acute respiratory distress syndrome: A multicentre prospective observational study. Lancet Respir Med. 2020; 8:1201–1208
Michard F, Vieillard-Baron A: Critically ill patients with COVID-19: Are they hemodynamically unstable and do we know why? Intensive Care Med. 2021; 47:254–255
Patel BV, Arachchillage DJ, Ridge CA, et al.: Pulmonary angiopathy in severe COVID-19: Physiologic, imaging, and hematologic observations. Am J Respir Crit Care Med. 2020; 202:690–699
Ackermann M, Verleden SE, Kuehnel M, et al.: Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020; 383:120–128
Akhmerov A, Marbán E: COVID-19 and the heart. Circ Res. 2020; 126:1443–1455
Li Y, Li H, Zhu S, et al.: Prognostic value of right ventricular longitudinal strain in patients with COVID-19. JACC Cardiovasc Imaging. 2020; 13:2287–2299
D’Alto M, Marra AM, Severino S, et al.: Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS. Crit Care. 2020; 24:670
Vieillard-Baron A, Charron C, Tran S, et al.: Echocardiographic patterns in critically ill COVID-19 patients. 2020. Available at: https://doi.org/10.21203/rs.3.rs-52431/v1 . Accessed June 11, 2021
Bleakley C, Singh S, Garfield B, et al.: Right ventricular dysfunction in critically ill COVID-19 ARDS. Int J Cardiol. 2020; 327:251–258
Vieillard-Baron A, Prigent A, Repessé X, et al.: Right ventricular failure in septic shock: Characterization, incidence and impact on fluid responsiveness. Crit Care. 2020; 24:630
Vieillard-Baron A, Price LC, Matthay MA: Acute cor pulmonale in ARDS. Intensive Care Med. 2013; 39:1836–1838
Repessé X, Charron C, Vieillard-Baron A: Right ventricular failure in acute lung injury and acute respiratory distress syndrome. Minerva Anestesiol. 2012; 78:941–948
Vieillard-Baron A, Bouferrache K, Charron C: Right ventricular function evaluation in acute respiratory distress syndrome: Back to the future. Crit Care Med. 2010; 38:1909–1910
Vieillard-Baron A, Naeije R, Haddad F, et al.: Diagnostic workup, etiologies and management of acute right ventricle failure: A state-of-the-art paper. Intensive Care Med. 2018; 44:774–790
Rudski LG, Lai WW, Afilalo J, et al.: Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23:685–713
Zochios V, Parhar K, Vieillard-Baron A: Protecting the right ventricle in ARDS: The role of prone ventilation. J Cardiothorac Vasc Anesth. 2018; 32:2248–2251
Ferguson ND, Fan E, Camporota L, et al.: The Berlin definition of ARDS: An expanded rationale, justification, and supplementary material. Intensive Care Med. 2012; 38:1573–1582
Stahl CA, Möller K, Schumann S, et al.: Dynamic versus static respiratory mechanics in acute lung injury and acute respiratory distress syndrome. Crit Care Med. 2006; 34:2090–2098
Beitler JR, Thompson BT, Matthay MA, et al.: Estimating dead-space fraction for secondary analyses of acute respiratory distress syndrome clinical trials. Crit Care Med. 2015; 43:1026–1035
Khanna A, English SW, Wang XS, et al.; ATHOS-3 Investigators: Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017; 377:419–430
Mason SE, Dieffenbach PB, Englert JA, et al.: Semi-quantitative visual assessment of chest radiography is associated with clinical outcomes in critically ill patients. Respir Res. 2019; 20:218
Afilalo J: The clinical frailty scale: Upgrade your eyeball test. Circulation. 2017; 135:2025–2027
Mahmoud-Elsayed HM, Moody WE, Bradlow WM, et al.: Echocardiographic findings in patients with COVID-19 pneumonia. Can J Cardiol. 2020; 36:1203–1207
Zaidi A, Knight DS, Augustine DX, et al.; Education Committee of the British Society of Echocardiography: Echocardiographic assessment of the right heart in adults: A practical guideline from the British Society of Echocardiography. Echo Res Pract. 2020; 7:G19–G41
Galiè N, Humbert M, Vachiery JL, et al.; ESC Scientific Document Group: 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37:67–119
Haines R, Crichton S, Wilson J, et al.: Cardiac biomarkers are associated with maximum stage of acute kidney injury in critically ill patients: A prospective analysis. Crit Care. 2017; 21:88
Renberg M, Jonmarker O, Kilhamn N, et al.: Renal resistive index is associated with acute kidney injury in COVID-19 patients treated in the intensive care unit. Ultrasound J. 2021; 13:3
Shah TG, Wadia SK, Kovach J, et al.: Echocardiographic parameters of right ventricular function predict mortality in acute respiratory distress syndrome: A pilot study. Pulm Circ. 2016; 6:155–160
Vieillard-Baron A, Schmitt JM, Augarde R, et al.: Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: Incidence, clinical implications, and prognosis. Crit Care Med. 2001; 29:1551–1555
Amgalan D, Pekson R, Kitsis RN: Troponin release following brief myocardial ischemia: Apoptosis versus necrosis. JACC Basic Transl Sci. 2017; 2:118–121
King KR, Aguirre AD, Ye YX, et al.: IRF3 and type I interferons fuel a fatal response to myocardial infarction. Nat Med. 2017; 23:1481–1487
Cheng KT, Xiong S, Ye Z, et al.: Caspase-11-mediated endothelial pyroptosis underlies endotoxemia-induced lung injury. J Clin Invest. 2017; 127:4124–4135
Toldo S, Mauro AG, Cutter Z, et al.: Inflammasome, pyroptosis, and cytokines in myocardial ischemia-reperfusion injury. Am J Physiol Heart Circ Physiol. 2018; 315:H1553–H1568
Miao N, Yin F, Xie H, et al.: The cleavage of gasdermin D by caspase-11 promotes tubular epithelial cell pyroptosis and urinary IL-18 excretion in acute kidney injury. Kidney Int. 2019; 96:1105–1120
Favaron E, Ince C, Hilty MP, et al.: Capillary leukocytes, microaggregates, and the response to hypoxemia in the microcirculation of coronavirus disease 2019 patients. Crit Care Med. 2021; 49:661–670
Metkus TS, Guallar E, Sokoll L, et al.: Prevalence and prognostic association of circulating troponin in the acute respiratory distress syndrome. Crit Care Med. 2017; 45:1709–1717
Gattinoni L, Vagginelli F, Carlesso E, et al.; Prone-Supine Study Group: Decrease in PaCO 2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med. 2003; 31:2727–2733
Giustiniano E, Fazzari F, Bragato RM, et al.: Trans-thoracic echocardiography in prone positioning COVID-19 patients: A small case series. SN Compr Clin Med. 2020 Sep 15. [online ahead of print]
Pagnesi M, Baldetti L, Beneduce A, et al.: Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19. Heart. 2020; 106:1324–1331
D’Andrea A, Scarafile R, Riegler L, et al.: Right ventricular function and pulmonary pressures as independent predictors of survival in patients with COVID-19 pneumonia. JACC Cardiovasc Imaging. 2020; 13:2467–2468
Zeng JH, Liu YX, Yuan J, et al.: First case of COVID-19 complicated with fulminant myocarditis: A case report and insights. Infection. 2020; 48:773–777
Sawalha K, Abozenah M, Kadado AJ, et al.: Systematic review of COVID-19 related myocarditis: Insights on management and outcome. Cardiovasc Revasc Med. 2021; 23:107–113
Lu KJ, Chen JX, Profitis K, et al.: Right ventricular global longitudinal strain is an independent predictor of right ventricular function: A multimodality study of cardiac magnetic resonance imaging, real time three-dimensional echocardiography and speckle tracking echocardiography. Echocardiography. 2015; 32:966–974