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Hahn RT, Badano L, Praz F, Muraru D, Agricola E, Ajmone Marsan N, Bartkowiak J, Delgado V, Dreyfus J, Hausleiter J, Lurz P, Maisano F, Margonato D, Messika-Zeitoun D, Enriquez-Sarano M, Cavalcante JL. The Last Decade in Tricuspid Regurgitation: How Imaging Shaped a Field. JACC Cardiovasc Imaging 2025:S1936-878X(25)00138-X. [PMID: 40298853 DOI: 10.1016/j.jcmg.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 03/11/2025] [Accepted: 03/20/2025] [Indexed: 04/30/2025]
Abstract
The tricuspid valve has become a major focus of novel structural heart interventions, with the Conformité Européenne approval of 5 devices in Europe and the U.S. Food and Drug Administration approval of 2 devices in the United States. Multiple meta-analyses and large population-based registries have shown that although significant tricuspid regurgitation (TR) often accompanies left heart or pulmonary vascular diseases, it is associated with an increased risk of mortality and a reduced quality of life after adjusting for these comorbidities. Echocardiography remains the imaging modality of choice for diagnosing the etiology and assessing the severity of TR. However, advanced imaging techniques have played an essential role in the rapid advancement of the structural field and, in particular, transcatheter interventions for TR. Herein, we review the advances made in this field, focusing on the role that imaging has played in shaping a new field of study.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Eustachio Agricola
- Valve Center IRCCS Ospedale San Raffaele, Cardiac Surgery, University Vita Salute, Milan, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Joanna Bartkowiak
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Bern University Hospital, University of Bern, Bern, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Hospital University Germans Trias I Pujol, Badalona, Spain
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Lurz
- Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Mainz, Germany
| | - Francesco Maisano
- Valve Center IRCCS Ospedale San Raffaele, Cardiac Surgery, University Vita Salute, Milan, Italy
| | - Davide Margonato
- Valve Center IRCCS Ospedale San Raffaele, Cardiac Surgery, University Vita Salute, Milan, Italy; Allina Health Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - João L Cavalcante
- Allina Health Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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Birtane D, Çukurova Z, Aşar S, Özmen D, Sertcakacılar G, Turhan FNÇ. The Effect of Prone Position on Right Ventricular Functions in CARDS: Is Survival Predictable when Evaluated Through Transesophageal Echocardiography? Turk J Anaesthesiol Reanim 2025; 53:53-61. [PMID: 40116456 PMCID: PMC11931261 DOI: 10.4274/tjar.2025.241830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 02/17/2025] [Indexed: 03/23/2025] Open
Abstract
Objective To evaluate the cardiopulmonary effect during prone position (PP) on right ventricular (RV) recovery in coronavirus disease-2019 related acute respiratory distress syndrome (C-ARDS) through transesophageal echocardiography (TEE). Methods This prospective study included 30 moderate-to-severe C-ARDS patients who were treated with PP in the first 48 h of invasive mechanical ventilation support. It was evaluated with TEE three times: before PP (T0f), the first hour of PP (T1), and the first hour of returning to the supine position (T0 + 24 h) (T2) after 23 hours of PP treatment. RV end-diastolic area/left ventricular (LV) end-diastolic area (RVEDA/LVEDA), tricuspid annular plane systolic excursion (TAPSE) and LV end-systolic eccentricity index were preferred RV evaluations as primary outcomes. Pulmonary effects of PP were evaluated as a secondary outcome, including PaO2/FiO2, driving pressure (dP), static compliance (Cstat), mechanical ventilation parameters, and their association with 28-day survival. Tissue DO2 was examined as a secondary outcome, and it was calculated using the measured cardiac output through TEE. Results With the cardiopulmonary effect of PP, the decrease in RVEDA/LVEDA, the increase in TAPSE, PaO2/FiO2, and Cstat, and the decrease in dP were statistically significant (P < 0.05). The Cstat value associated with 28-day survival showed decreased mortality for each unit increase. The Cstat cut-off value, which was statistically significant for survival, was 37. Conclusion PP can improve RV recovery and oxygenation, but it isn't always accompanied by increased survival. An increase in the Cstat may improve survival without the development of RV dysfunction while maintaining heart-lung interaction.
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Affiliation(s)
- Dicle Birtane
- University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, Intensive Care Unit, İstanbul, Türkiye
| | - Zafer Çukurova
- University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, Intensive Care Unit, İstanbul, Türkiye
| | - Sinan Aşar
- University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, Intensive Care Unit, İstanbul, Türkiye
| | - Damla Özmen
- University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, İstanbul, Türkiye
| | - Gökhan Sertcakacılar
- University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, İstanbul, Türkiye
- Outcomes Research Consortium, Houston, Texas, USA
| | - Fatma Nihan Çağlar Turhan
- University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Cardiology, İstanbul, Türkiye
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Zakynthinos GE, Tsolaki V, Mantzarlis K, Xanthopoulos A, Oikonomou E, Kalogeras K, Siasos G, Vavuranakis M, Makris D, Zakynthinos E. Navigating Heart-Lung Interactions in Mechanical Ventilation: Pathophysiology, Diagnosis, and Advanced Management Strategies in Acute Respiratory Distress Syndrome and Beyond. J Clin Med 2024; 13:7788. [PMID: 39768712 PMCID: PMC11728210 DOI: 10.3390/jcm13247788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 12/13/2024] [Accepted: 12/17/2024] [Indexed: 01/16/2025] Open
Abstract
Patients in critical condition who require mechanical ventilation experience intricate interactions between their respiratory and cardiovascular systems. These complex interactions are crucial for clinicians to understand as they can significantly influence therapeutic decisions and patient outcomes. A deep understanding of heart-lung interactions is essential, particularly under the stress of mechanical ventilation, where the right ventricle plays a pivotal role and often becomes a primary concern. Positive pressure ventilation, commonly used in mechanical ventilation, impacts right and left ventricular pre- and afterload as well as ventricular interplay. The right ventricle is especially susceptible to these changes, and its function can be critically affected, leading to complications such as right heart failure. Clinicians must be adept at recognizing and managing these interactions to optimize patient care. This perspective will analyze this matter comprehensively, covering the pathophysiology of these interactions, the monitoring of heart-lung dynamics using the latest methods (including ECHO), and management and treatment strategies for related conditions. In particular, the analysis will delve into the efficacy and limitations of various treatment modalities, including pharmaceutical interventions, nuanced ventilator management strategies, and advanced devices such as extracorporeal membrane oxygenation (ECMO). Each approach will be examined for its impact on optimizing right ventricular function, mitigating complications, and ultimately improving patient outcomes in the context of mechanical ventilation.
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Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (K.K.); (G.S.); (M.V.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (K.M.); (D.M.)
| | - Kostantinos Mantzarlis
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (K.M.); (D.M.)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (K.K.); (G.S.); (M.V.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (K.K.); (G.S.); (M.V.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (K.K.); (G.S.); (M.V.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (K.K.); (G.S.); (M.V.)
| | - Demosthenes Makris
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (K.M.); (D.M.)
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (K.M.); (D.M.)
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Rottmann FA, Glück C, Kaier K, Bemtgen X, Supady A, von Zur Mühlen C, Westermann D, Wengenmayer T, Staudacher DL. Myocarditis incidence and hospital mortality from 2007 to 2022: insights from a nationwide registry. Clin Res Cardiol 2024:10.1007/s00392-024-02494-3. [PMID: 39186178 DOI: 10.1007/s00392-024-02494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/05/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES To investigate the burden of disease of myocarditis in Germany and identify similarities and differences in myocarditis with or without COVID-19. METHODS All patients hospitalized with myocarditis in Germany were included in this nationwide retrospective analysis. Data were retrieved from the Federal Statistical Office of Germany (DESTATIS) for the years from 2007 to 2022. The primary endpoint was hospital mortality. RESULTS A total of 88,159 patients hospitalized with myocarditis were analyzed. Annual cases increased from 5100 in 2007 to 6593 in 2022 (p < 0.001 for trend) with higher incidence during winter months. Incidence per 100,000 inhabitants was 6.2 in 2007 rising to 7.8 in 2022 (p < 0.001 for trend). Hospital mortality remained constant at an average of 2.44% (p = 0.164 for trend). From 2020 to 2022, 1547/16,229 (9.53%) patients were hospitalized with both, myocarditis and COVID-19 (incidence 0.62/100,000 inhabitants and 180/100,000 hospitalizations with COVID-19). These patients differed significantly in most patient characteristics and had a higher rate of hospital mortality compared to myocarditis without COVID-19 (12.54% vs. 2.26%, respectively, p < 0.001). CONCLUSIONS Myocarditis hospitalizations were slowly rising over the past 16 years with hospital mortality remaining unchanged. Incidence of hospitalizations with combined myocarditis and COVID-19 was low, but hospital mortality was high.
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Affiliation(s)
- Felix A Rottmann
- Department of Medicine IV Nephrology and Primary Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Glück
- Interdisciplinary Medical Intensive Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- Department of Cardiology, Pneumology, Angiology and Intensive Care, Ortenau Clinical Center Offenburg-Kehl, Offenburg, Germany
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Interdisciplinary Medical Intensive Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Sartini S, Ferrari L, Cutuli O, Castellani L, Cristina ML, Arboscello E, Sartini M. The Role of POCUS to Face COVID-19: A Narrative Review. J Clin Med 2024; 13:2756. [PMID: 38792298 PMCID: PMC11121862 DOI: 10.3390/jcm13102756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
COVID-19 has been a challenging outbreak to face, with millions of deaths among the globe. Acute respiratory failure due to interstitial pneumonia was the leading cause of death other than prothrombotic activation and complications. Lung ultrasound (LUS) and point-of-care ultrasound (POCUS) are widely used not only to triage, to identify, and to monitor lungs involvement but also to assess hemodynamic status and thrombotic and hemorrhagic complications, mainly in critically ill patients. POCUS has gained growing consideration due to its bedside utilization, reliability, and reproducibility even in emergency settings especially in unstable patients. In this narrative review, we aim to describe LUS and POCUS utilization in COVID-19 infection based on the literature found on this topic. We reported the LUS patterns of COVID-19 pulmonary infection, the diagnostic accuracy with respect to CT lung scan, its prognostic value, the variety of scores and protocols proposed, and the utilization of POCUS to investigate the extra-lung complications.
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Affiliation(s)
- Stefano Sartini
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Lorenzo Ferrari
- Emergency Medicine Post-Graduate School, University of Genoa, Via Balbi 5, 16126 Genoa, Italy;
| | - Ombretta Cutuli
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Luca Castellani
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
| | - Eleonora Arboscello
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
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Tonini A, Vergara C, Regazzoni F, Dede' L, Scrofani R, Cogliati C, Quarteroni A. A mathematical model to assess the effects of COVID-19 on the cardiocirculatory system. Sci Rep 2024; 14:8304. [PMID: 38594376 PMCID: PMC11004160 DOI: 10.1038/s41598-024-58849-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Impaired cardiac function has been described as a frequent complication of COVID-19-related pneumonia. To investigate possible underlying mechanisms, we represented the cardiovascular system by means of a lumped-parameter 0D mathematical model. The model was calibrated using clinical data, recorded in 58 patients hospitalized for COVID-19-related pneumonia, to make it patient-specific and to compute model outputs of clinical interest related to the cardiocirculatory system. We assessed, for each patient with a successful calibration, the statistical reliability of model outputs estimating the uncertainty intervals. Then, we performed a statistical analysis to compare healthy ranges and mean values (over patients) of reliable model outputs to determine which were significantly altered in COVID-19-related pneumonia. Our results showed significant increases in right ventricular systolic pressure, diastolic and mean pulmonary arterial pressure, and capillary wedge pressure. Instead, physical quantities related to the systemic circulation were not significantly altered. Remarkably, statistical analyses made on raw clinical data, without the support of a mathematical model, were unable to detect the effects of COVID-19-related pneumonia in pulmonary circulation, thus suggesting that the use of a calibrated 0D mathematical model to describe the cardiocirculatory system is an effective tool to investigate the impairments of the cardiocirculatory system associated with COVID-19.
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Affiliation(s)
- Andrea Tonini
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy.
| | - Christian Vergara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, Milan, Italy
| | | | - Luca Dede'
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Roberto Scrofani
- UOC Cardiochirurgia Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Chiara Cogliati
- Internal Medicine, L. Sacco Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Dandel M. Assessment of COVID-19-related right ventricular morphological and functional alterations and evaluation of their impact on the course of the disease. Ann Intensive Care 2024; 14:39. [PMID: 38530515 DOI: 10.1186/s13613-024-01278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Michael Dandel
- German Centre for Cardiovascular Research, 13347, Berlin, Germany.
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Dandel M. Monitoring of the right ventricular responses to pressure overload: prognostic value and usefulness of echocardiography for clinical decision-making. Cardiovasc Diagn Ther 2024; 14:193-222. [PMID: 38434557 PMCID: PMC10904302 DOI: 10.21037/cdt-23-380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024]
Abstract
Regardless of whether pulmonary hypertension (PH) results from increased pulmonary venous pressure in left-sided heart diseases or from vascular remodeling and/or obstructions in pre-capillary pulmonary vessels, overload-induced right ventricular (RV) dysfunction and its final transition into right-sided heart failure is a major cause of death in PH patients. Being particularly suited for non-invasive monitoring of the right-sided heart, echocardiography has become a useful tool for optimizing the therapeutic decision-making and evaluation of therapy results in PH. The review provides an updated overview on the pathophysiological insights of heart-lung interactions in PH of different etiology, as well as on the diagnostic and prognostic value of echocardiography for monitoring RV responses to pressure overload. The article focuses particularly on the usefulness of echocardiography for predicting life-threatening aggravation of RV dysfunction in transplant candidates with precapillary PH, as well as for preoperative prediction of post-operative RV failure in patients with primary end-stage left ventricular (LV) failure necessitating heart transplantation or a LV assist device implantation. In transplant candidates with refractory pulmonary arterial hypertension, a timely prediction of impending RV decompensation can contribute to reduce both the mortality risk on the transplant list and the early post-transplant complications caused by severe RV dysfunction, and also to avoid combined heart-lung transplantation. The review also focuses on the usefulness of echocardiography for monitoring the right-sided heart in patients with acute respiratory distress syndrome, particularly in those with refractory respiratory failure requiring extracorporeal membrane oxygenation support. Given the pathophysiologic particularity of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection to be associated with a high incidence of thrombotic microangiopathy-induced increase in the pulmonary resistance, echocardiography can improve the selection of temporary mechanical cardio-respiratory support strategies and can therefore contribute to the reduction of mortality rates. On the whole, the review aims to provide a theoretical and practical basis for those who are or intend in the future to be engaged in this highly demanding field.
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Dayıoğlu M, Gürsel G, Özercan S, Aydın EM, Nadastepe Ö. Performance of handheld ultrasound devices in diagnosis of pulmonary hypertension and right heart dysfunction in ICU patients. Echocardiography 2024; 41:e15721. [PMID: 38041481 DOI: 10.1111/echo.15721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/30/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023] Open
Abstract
AIM The use of handheld ultrasonography devices (HHUD) has increased recently but there are limited data about their performance in the evaluation of right heart dysfunction (RHD) and pulmonary hypertension (PHT). The aim of the study is to compare the performance of a HHUD with a conventional ultrasound device (CUD) in assessing PHT and RHD. METHODS This single-center prospective study was performed in a seven-bed teaching hospital intensive care unit (ICU). PHT and RHD criteria were compared by HHUD and CUD. Additional PHT criteria and right ventricle (RV) systolic and diastolic dysfunction criteria were also measured. RESULTS Forty-six patients were included in the study. There was no significant difference between the imaging rates and mean values of the parameters measured by both devices. When the positivity rates for additional PHT parameters and RHD criteria were compared, there were no significant differences between the devices. In Bland-Altman's analysis, there was good agreement and there was no bias between the measurements of the two devices but left ventricular end-systolic eccentricity index (LVSEI), right atrium area (RAA), and pulmonary artery diameter (PAD). Ninety percent of the patients had PHT probability, of whom 43% had a low, 37% had intermediate and 10% had a high probability of PHT. Ninety-two percent of the patients had RHD and there was no significant difference between the devices in the diagnosis of RHD (p = .212). When RV systolic and diastolic dysfunction evaluations of the devices were compared according to the British Society of Echocardiography (BSE) criteria there was no significant difference between the devices' measurements in the evaluation of systolic and diastolic function. CONCLUSION The imaging and measurement capabilities of the HHUDs for PHT and RHD parameters were similar to CUDs, and considering the inconsistent parameters, the HHUD can be useful in diagnosing these problems.
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Affiliation(s)
- Mürüvvet Dayıoğlu
- Critical Care Fellowship Program, Gazi University School of Medicine, Ankara, Turkey
| | - Gül Gürsel
- Department of Pulmonary Disease, Division of Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Seçil Özercan
- Critical Care Fellowship Program, Gazi University School of Medicine, Ankara, Turkey
| | - Eda Macit Aydın
- Critical Care Fellowship Program, Gazi University School of Medicine, Ankara, Turkey
| | - Özge Nadastepe
- Critical Care Fellowship Program, Gazi University School of Medicine, Ankara, Turkey
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Omar AMS, Chilimuri S, Bella JN. Editorial: The heart lung disease: a need for novel definitions and understanding of pathological overlaps in the COVID-19 era and beyond. Front Cardiovasc Med 2023; 10:1329841. [PMID: 38162129 PMCID: PMC10757605 DOI: 10.3389/fcvm.2023.1329841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Alaa Mabrouk Salem Omar
- Department of Cardiology, Mount Sinai Morningside, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Cardiology, BronxCare Hospital Center, Bronx, NY, United States
| | - Sridhar Chilimuri
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Cardiology, BronxCare Hospital Center, Bronx, NY, United States
- Department of Medicine, BronxCare Hospital System, Bronx, NY, United States
| | - Jonathan N. Bella
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Cardiology, BronxCare Hospital Center, Bronx, NY, United States
- Department of Medicine, BronxCare Hospital System, Bronx, NY, United States
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11
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Dandel M. Challenges in the evaluation of Covid-19 related cardiac alterations early after recovery from acute infection associated with severe lung involvement : Letter to the editor regarding the article "Paradoxical increase in left atrial strains early after Covid-19 infection, a result of comprehensive recovery phase four-chamber strains study", by Samiei N. et al. Int J cardiovasc imaging. 2023 May 10:1-11. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1871-1872. [PMID: 37421579 DOI: 10.1007/s10554-023-02900-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK), Partner site Berlin, 13347, Berlin, Germany.
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12
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Weisz SH, Attena E, Caturano A, Annunziata A, Halasz G, Conte M, Parisi V, Severino L, Sasso FC, Fiorentino G, Severino S, Russo V. Right ventricular electrocardiographic abnormalities among hospitalized COVID-19 patients: Simple marker of worst clinical outcome. J Electrocardiol 2023; 80:162-165. [PMID: 37451132 DOI: 10.1016/j.jelectrocard.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Sara Hana Weisz
- Division of Cardiology, Cotugno Hospital - AORN dei Colli, Naples, Italy
| | - Emilio Attena
- Division of Cardiology, Monaldi Hospital - AORN dei Colli, Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Annunziata
- Subintensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital -AORN dei Colli, Naples, Italy
| | - Geza Halasz
- Cardiology Department, Guglielmo Da Saliceto Hospital, Piacenza, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Laura Severino
- Division of Cardiology, Cotugno Hospital - AORN dei Colli, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Fiorentino
- Subintensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital -AORN dei Colli, Naples, Italy
| | - Sergio Severino
- Division of Cardiology, Cotugno Hospital - AORN dei Colli, Naples, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy.
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13
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Dandel M. Echocardiography Can Improve the Selection of Mechanical Support Strategies for Patients With Severe COVID-19 Respiratory Distress Syndrome. ASAIO J 2023; 69:e418. [PMID: 37145832 DOI: 10.1097/mat.0000000000001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK) Partner Site Berlin, Berlin, Germany
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14
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Passi R, Brittan M, Baker AH. The role of the endothelium in severe acute respiratory syndrome coronavirus 2 infection and pathogenesis. CURRENT OPINION IN PHYSIOLOGY 2023; 34:100670. [PMID: 37159613 PMCID: PMC10066588 DOI: 10.1016/j.cophys.2023.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Endothelial cell (EC) dysfunction is a characteristic complication of coronavirus-19 (COVID-19). This review discusses the role of the endothelium during the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with a focus on different vascular beds, possible routes of infectivity and the impact of EC dysfunction across multiple organ systems. It is now known that COVID-19 disease elicits a distinct transcriptomic and molecular profile that is different to other viral infections, such as Influenza A (H1N1). Interestingly, there is also a suggested interplay between the heart and lungs that promotes the amplification of inflammatory cascades, leading to an exacerbation in disease severity. Multiomic studies have informed common pathways that may be responsible for endothelial activation while also highlighting key differences in COVID-19 pathogenesis between organ systems. At a pathological level, endothelialitis is an endpoint result regardless of either a direct viral infection or via indirect effects independent of infection. Understanding if ECs are directly targeted by SARS-CoV-2 or are collaterally damaged amid a cytokine storm originating from other cells and organs can provide novel insights into disease progression and may highlight possible new therapeutic opportunities targeted at the damaged endothelium.
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Affiliation(s)
- Rainha Passi
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Mairi Brittan
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Andrew H Baker
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
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15
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Brown TN, Brogan TV. Right ventricular dysfunction in patients with acute respiratory distress syndrome receiving venovenous extracorporeal membrane oxygenation. Front Cardiovasc Med 2023; 10:1027300. [PMID: 37265572 PMCID: PMC10229794 DOI: 10.3389/fcvm.2023.1027300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/10/2023] [Indexed: 06/03/2023] Open
Abstract
Acute respiratory distress syndrome is characterized by non-cardiogenic pulmonary edema, decreased pulmonary compliance, and abnormalities in gas exchange, especially hypoxemia. Patients with acute respiratory distress syndrome (ARDS) who receive support with venovenous (V-V) extracorporeal membrane oxygenation (ECMO) usually have severe lung disease. Many patients with ARDS have associated pulmonary vascular injury which can result in elevated pulmonary vascular resistance and right heart dysfunction. Since V-V ECMO relies upon preserved cardiac function, right heart failure has important implications for patient evaluation, management, and outcomes. Worsening right heart function complicates ARDS and disease processes. Given the increasing use of ECMO to support patients with ARDS, an understanding of right ventricular-ECMO and cardiopulmonary interactions is essential for the clinician. A narrative review of the manifestations of right heart dysfunction, as well as diagnosis and management strategies for the patient with ARDS on ECMO, is provided.
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Affiliation(s)
- Tyler N. Brown
- Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington, United States
| | - Thomas V. Brogan
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington, United States
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16
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Lazzeri C, Bonizzoli M, Batacchi S, Cianchi G, Franci A, Socci F, Chiostri M, Peris A. Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support. World J Cardiol 2023; 15:165-173. [PMID: 37124973 PMCID: PMC10130894 DOI: 10.4330/wjc.v15.i4.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/15/2022] [Accepted: 03/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The prognostic role of right ventricle dilatation and dysfunction (RVDD) has not been elucidated in patients with coronavirus disease (COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation (ECMO) support.
AIM To assess whether pre veno-venous (VV) ECMO RVDD were related to in-intensive care unit (ICU) mortality.
METHODS We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU (an ECMO referral center) from 31th March 2020 to 31th August 2021. An echocardiographic exam was performed immediately before VV ECMO implantation.
RESULTS Males were prevalent (73.8%) and patients with a body mass index > 30 kg/m2 were the majority (46/61, 75%). The overall in-ICU mortality rate was 54.1% (33/61). RVDD was detectable in more than half of the population (34/61, 55.7%) and associated with higher simplified organ functional assessment (SOFA) values (P = 0.029) and a longer mechanical ventilation duration prior to ECMO support (P = 0.046). Renal replacement therapy was more frequently needed in RVDD patients (P = 0.002). A higher in-ICU mortality (P = 0.024) was observed in RVDD patients. No echo variables were independent predictors of in-ICU death.
CONCLUSION In patients with COVID-related respiratory failure on ECMO support, RVDD (dilatation and dysfunction) is a common finding and identifies a subset of patients characterized by a more severe disease (as indicated by higher SOFA values and need of renal replacement therapy) and by a higher in-ICU mortality. RVDD (also when considered separately) did not result independently associated with in-ICU mortality in these patients.
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17
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Mahfooz K. Comment on: Echocardiographic 60-day mortality markers in patients hospitalized in intensive care for COVID-19. Heart Lung 2023; 58:247-248. [PMID: 36609121 PMCID: PMC9771747 DOI: 10.1016/j.hrtlng.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Kamran Mahfooz
- New York City Health and Hospitals Corporation, United States of America.
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18
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Baloescu C, Weingart GE, Moore CL. Emergency Department Point-Of-Care Echocardiography and Lung Ultrasound in Predicting COVID-19 Severity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36840721 DOI: 10.1002/jum.16205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES We sought to determine if point-of-care ultrasound (POCUS) performed on patients with COVID-19 in the emergency department (ED) can help predict disease course, severity, or identify complications. METHODS This was a retrospective cohort study of adult ED patients who tested positive for COVID-19 at hospital admission or within 2 weeks of presentation and received heart or lung POCUS. Clips were reviewed for presence of decreased left ventricular ejection fraction (LVEF), right ventricular dilation, presence of B-lines, and pleural line abnormalities. Patients with worsening hypoxemic respiratory failure or shock requiring higher level of care and patients who expired were considered to have developed severe COVID-19. Regression analysis was performed to determine if there was a correlation between ED POCUS findings and development of severe COVID-19. RESULTS A total of 155 patients met study criteria; 148 patients had documented cardiac views and 116 patients had documented lung views (113 with both). Mean age was 66.5 years old (±18.6) and 53% of subjects were female. Subjects with decreased LVEF that was not previously documented had increased odds of having severe COVID during their hospitalization compared to those with old or no dysfunction (OR 5.66, 95% CI: 1.55-19.95, P = .08). The presence of pleural line abnormalities was also predictive for development of severe COVID (OR 2.68, 95% CI: 1.04-6.92, P = .04). CONCLUSION POCUS findings of previously unidentified decreased LVEF and pleural line abnormalities in patients with COVID-19 evaluated in the ED were correlated to a more severe clinical course and worse prognosis.
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Affiliation(s)
- Cristiana Baloescu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriel E Weingart
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher L Moore
- Department of Emergency, Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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19
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Dandel M. Right Ventricular Dilation on Echocardiogram: An Early Indication of Higher In-Hospital Mortality Risk Among Patients With SARS-CoV-2 Pneumonia. J Am Soc Echocardiogr 2023; 36:565. [PMID: 36773816 PMCID: PMC9911972 DOI: 10.1016/j.echo.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK), Berlin, Germany.
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20
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Dandel M. Letter to the editor "Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients". J Crit Care 2023; 73:154217. [PMID: 36379138 PMCID: PMC9653088 DOI: 10.1016/j.jcrc.2022.154217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK) Partner Site Berlin, Berlin, Germany.
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21
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Bonizzoli M, Lazzeri C, Cianchi G, Guetti C, Fulceri GE, Socci F, Peris A. Effects of rescue inhaled nitric oxide on right ventricle and pulmonary circulation in severe COVID-related acute respiratory distress syndrome. J Crit Care 2022; 72:153987. [PMID: 35120777 PMCID: PMC8806881 DOI: 10.1016/j.jcrc.2022.153987] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSES To assess the effects of inhaled Nitric Oxide (iNO) on right ventricle dimension and function and systolic pulmonary arterial pressures in severe Acute Respiratory Distress (ARDS) due to Sars-Cov2 (COVID) infection. MATERIALS AND METHODS We assessed the effects of iNO on right ventricle dimension and function and systolic pulmonary arterial pressures in 12 consecutive COVID-related ARDS patients by means of serial echocardiographic exams (baseline, 12 and 24 h since iNO start). RESULTS Inhaled NO administration did not influence systolic pulmonary arterial pressures nor RV dimension and function. No changes were detectable in ventilatory data with iNO administration. Considering the negligible effect on oxygenation, iNO use was discontinued in all cases. CONCLUSIONS In COVID-related severe ARDS iNO administrated as rescue therapy is not able to ameliorate oxygenation nor pulmonary hypertension, as assessed by serial echocardiograms. This finding may be explained by the diffuse loss of hypoxic pulmonary vasoconstriction with increased perfusion around alveolar consolidations which characterizes COVID-related severe ARDS.
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Affiliation(s)
- Manuela Bonizzoli
- Corresponding author at: Intensive Care Unit and Regional, ECMO Referral Centre Emergency Department, Largo Brambilla 3, 50134 Florence, Italy
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22
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Ito GNW, Rodrigues VAC, Hümmelgen J, Meschino GSPG, Abou‐Rejaile GM, Brenny ID, de Castro Júnior CR, Artigas RC, Munhoz JPS, Cardoso GC, Picheth GF. COVID-19 pathophysiology and ultrasound imaging: A multiorgan review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:326-338. [PMID: 35218034 PMCID: PMC9088355 DOI: 10.1002/jcu.23160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 05/09/2023]
Abstract
COVID-19 is a dynamic disease and may affect different tissues and organs as it progresses. Therefore, the impact generated by the disease in all its stages and organs requires a functional and versatile imaging technique able to detect particularities or artifacts dynamically. Ultrasonography fulfills all these requirements and exhibit several advantages relative to other imaging modalities, including portability, lower cost and biosafety. Throughout the COVID-19 pandemic, ultrasonography displayed a crucial role in the triage, monitoring, indicating organ damages and enabling individualized therapeutical decisions in COVID-19 patients. This review is dedicated to highlight the main pathological effects correlated with ultrasound changes caused by COVID-19 in the lungs, heart and liver.
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Affiliation(s)
- Giovana N. W. Ito
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | - Juliana Hümmelgen
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | | | - Isadora D. Brenny
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | - Rafaela C. Artigas
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | | | - Guilherme F. Picheth
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
- Department of Basic PathologyFederal University of ParanáCuritibaBrazil
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23
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Scudiero F, Silverio A, Muraca I, Russo V, Di Maio M, Silvestro A, Personeni D, Citro R, Canonico ME, Galasso G, Porto I, Parodi G. Long-Term Prognostic Impact of Right Ventricular Dysfunction in Patients with COVID-19. J Pers Med 2022; 12:162. [PMID: 35207651 PMCID: PMC8876743 DOI: 10.3390/jpm12020162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 01/10/2023] Open
Abstract
The characteristics and clinical course of hospitalized patients with coronavirus disease 2019 (COVID-19) have been widely described, while long-term data are still poor. The aim of this study was to evaluate the long-term clinical outcome and its association with right ventricular (RV) dysfunction in hospitalized patients with COVID-19. This was a prospective multicenter study of consecutive COVID-19 patients hospitalized at seven Italian Hospitals from 28 February to 20 April 2020. The study population was divided into two groups according to echocardiographic evidence of RV dysfunction. The primary study outcome was 1-year mortality. The propensity score matching was performed to balance for potential baseline confounders. The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); RV dysfunction was diagnosed in 63 cases (28%). Patients with RV dysfunction were older (75 vs. 67 years, p < 0.001), had higher prevenance of coronary artery disease (27% vs. 11%, p = 0.003), and lower left ventricular ejection fraction (50% vs. 55%, p < 0.001). The rate of 1-year mortality (67% vs. 28%; p ≤ 0.001) was significantly higher in patients with RV dysfunction compared with patients without. After propensity score matching, patients with RV dysfunction showed a worse long-term survival (62% vs. 29%, p < 0.001). The multivariable Cox regression model showed an independent association of RV dysfunction with 1-year mortality. RV dysfunction is a relatively common finding in hospitalized COVID-19 patients, and it is independently associated with an increased risk of 1-year mortality.
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Affiliation(s)
- Fernando Scudiero
- Division of Cardiology, “Bolognini” Hospital, ASST Bergamo est, 24068 Seriate, Italy; (F.S.); (A.S.); (D.P.)
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Iacopo Muraca
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, 50141 Florence, Italy;
| | - Vincenzo Russo
- Division of Cardiology Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”—Monaldi and Cotugno Hospital, 81100 Naples, Italy;
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Antonio Silvestro
- Division of Cardiology, “Bolognini” Hospital, ASST Bergamo est, 24068 Seriate, Italy; (F.S.); (A.S.); (D.P.)
| | - Davide Personeni
- Division of Cardiology, “Bolognini” Hospital, ASST Bergamo est, 24068 Seriate, Italy; (F.S.); (A.S.); (D.P.)
| | - Rodolfo Citro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Mario Enrico Canonico
- Cardiology Clinic, Sassari University Hospital, 07100 Sassari, Italy; (M.E.C.); (G.P.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, 16132 Genoa, Italy;
| | - Guido Parodi
- Cardiology Clinic, Sassari University Hospital, 07100 Sassari, Italy; (M.E.C.); (G.P.)
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24
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Lazzeri C, Bonizzoli M, Peris A. The Clinical Role of Right Ventricle Changes in COVID-19 Respiratory Failure Depends on Disease Severity. J Cardiothorac Vasc Anesth 2021; 36:922-923. [PMID: 34937675 PMCID: PMC8685304 DOI: 10.1053/j.jvca.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department, Florence, Italy
| | - Adirano Peris
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department, Florence, Italy
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25
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Bonnemain J, Ltaief Z, Liaudet L. The Right Ventricle in COVID-19. J Clin Med 2021; 10:jcm10122535. [PMID: 34200990 PMCID: PMC8230058 DOI: 10.3390/jcm10122535] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop various cardiac complications, among which dysfunction of the right ventricle (RV) appears particularly common, especially in severe forms of the disease, and which is associated with a dismal prognosis. Echocardiographic studies indeed reveal right ventricular dysfunction in up to 40% of patients, a proportion even greater when the RV is explored with strain imaging echocardiography. The pathophysiological mechanisms of RV dysfunction in COVID-19 include processes increasing the pulmonary vascular hydraulic load and others reducing RV contractility, which precipitate the acute uncoupling of the RV with the pulmonary circulation. Understanding these mechanisms provides the fundamental basis for the adequate therapeutic management of RV dysfunction, which incorporates protective mechanical ventilation, the prevention and treatment of pulmonary vasoconstriction and thrombotic complications, as well as the appropriate management of RV preload and contractility. This comprehensive review provides a detailed update of the evidence of RV dysfunction in COVID-19, its pathophysiological mechanisms, and its therapy.
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Affiliation(s)
- Jean Bonnemain
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland; (J.B.); (Z.L.)
| | - Zied Ltaief
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland; (J.B.); (Z.L.)
| | - Lucas Liaudet
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland; (J.B.); (Z.L.)
- Division of Pathophysiology, Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-79-556-4278
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