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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Echocardiography | Research

Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS

Authors: Michele D’Alto, Alberto M. Marra, Sergio Severino, Andrea Salzano, Emanuele Romeo, Rosanna De Rosa, Francesca Maria Stagnaro, Gianpiero Pagnano, Raffaele Verde, Patrizia Murino, Andrea Farro, Giovanni Ciccarelli, Maria Vargas, Giuseppe Fiorentino, Giuseppe Servillo, Ivan Gentile, Antonio Corcione, Antonio Cittadini, Robert Naeije, Paolo Golino

Published in: Critical Care | Issue 1/2020

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Abstract

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.
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Metadata
Title
Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS
Authors
Michele D’Alto
Alberto M. Marra
Sergio Severino
Andrea Salzano
Emanuele Romeo
Rosanna De Rosa
Francesca Maria Stagnaro
Gianpiero Pagnano
Raffaele Verde
Patrizia Murino
Andrea Farro
Giovanni Ciccarelli
Maria Vargas
Giuseppe Fiorentino
Giuseppe Servillo
Ivan Gentile
Antonio Corcione
Antonio Cittadini
Robert Naeije
Paolo Golino
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03385-5

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