Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes.

COVID-19 Chest CT-angiogram RV:LV ratio Right ventricular dilation

Journal

The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology
ISSN: 2090-911X
Titre abrégé: Egypt Heart J
Pays: Germany
ID NLM: 9106952

Informations de publication

Date de publication:
08 May 2022
Historique:
received: 05 09 2021
accepted: 20 04 2022
entrez: 8 5 2022
pubmed: 9 5 2022
medline: 9 5 2022
Statut: epublish

Résumé

Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease. We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1. In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.

Sections du résumé

BACKGROUND BACKGROUND
Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease.
RESULTS RESULTS
We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1.
CONCLUSIONS CONCLUSIONS
In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.

Identifiants

DOI: 10.1186/s43044-022-00274-w PMID: 35527310 PMC: PMC9080642
pubmed: 35527310
doi: 10.1186/s43044-022-00274-w
pii: 10.1186/s43044-022-00274-w
pmc: PMC9080642
doi:

Types de publication

Journal Article

Langues

eng

Pagination

37

Subventions

Organisme : NCATS NIH HHS
ID : UL1 TR002373
Pays : United States
Organisme : NIH National Center for Advancing Translational Sciences (NCATS)
ID : UL1TR002373

Informations de copyright

© 2022. The Author(s).

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Auteurs

Ran Tao (R)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
ORCID: 0000-0002-3234-6028

Zuzana Burivalova (Z)

Nelson Institute for Environmental Studies, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

S Carolina Masri (SC)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Naga Dharmavaram (N)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Aurangzeb Baber (A)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Roderick Deaño (R)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Timothy Hess (T)

Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Ravi Dhingra (R)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

James Runo (J)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Medicine-Division of Pulmonary and Critical Care, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Nizar Jarjour (N)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Medicine-Division of Pulmonary and Critical Care, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Rebecca R Vanderpool (RR)

Department of Biomedical Engineering, The University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ, 85721, USA.

Naomi Chesler (N)

Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA, 92697, USA.

Joanna E Kusmirek (JE)

Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Marlowe Eldridge (M)

Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.

Christopher Francois (C)

Mayo Clinic Radiology, 200 First St. SW, Rochester, MN, 55905, USA.

Farhan Raza (F)

Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA. fraza@medicine.wisc.edu.
Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA. fraza@medicine.wisc.edu.

Classifications MeSH