McConnell's sign assessed by point-of-care cardiac ultrasound associated with in-hospital mortality of COVID-19 patients with respiratory failure

Excerpt

In the coronavirus disease 2019 (COVID-19) pandemic, many patients have suffered from respiratory failure with cardiac impairment. Guo et al. [1] reported that in 187 hospitalized patients with COVID-19, 52 (27.8%) had myocardial injury. In particular, right ventricular (RV) dysfunction is a common condition among patients with COVID-19 and cardiac injury and is associated with a higher risk of in-hospital mortality [2]. Additionally, RV global longitudinal strain assessed by transthoracic echocardiography (TTE) was able to predict a higher risk of mortality in COVID-19 patients, independently of, and incrementally to other echocardiographic parameters such as RV fractional area change (FAC) [3]. However, to reduce staff exposure to COVID-19 infection, the American Society of Echocardiography recommends a point-of-care cardiac ultrasound (POCUS) for the assessment of cardiac structure and function in patients with COVID-19 [4]. The clinical benefit of POCUS in patients with COVID-19 has been poorly documented; therefore, we focused on the use of McConnell’s sign as an indication of RV dysfunction. McConnell’s sign has been described as highly specific for acute pulmonary embolism right ventricular free wall hypokinesis with apical sparing when assessed by echocardiography [5]. We aimed to investigate the association between the severity of RV and McConnell’s sign assessed by POCUS in the critical care of patients with COVID-19. …