Abstract
Introduction:
COVID-19 is a growing pandemic that confers augmented risk for RV dysfunction and dilation; prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain.
Hypothesis:
To test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification.
Methods:
Consecutive adult COVID-19 patients undergoing clinical transthoracic echo at three NYC hospitals were studied; images were analyzed by a central core lab blinded to clinical and biomarker data.
Results:
Of 510 patients (64±14 years, 66% male) studied, RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p=0.015). During inpatient follow-up (median 20 days), there were 165 deaths (32%) and 229 discharges (45%). RV dysfunction (HR 2.25 [CI 1.26-3.98]; p=0.006) and dilation (HR 1.82 [CI 1.11-2.97]; p=0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR 1.39 [CI 1.01-1.90]; p=0.04).
Figure 1A
demonstrates prognostic utility for each echo-quantified RV parameter (p<0.05) in relation to all-cause mortality.
Figure 1B
shows RV indices to provide risk stratification beyond biomarker strata, as evidenced by greatest risk for death among patients with both adverse RV remodeling and positive biomarkers, and lesser risk among patients with isolated biomarker elevations. RV remodeling conferred over a 2-fold increase in mortality risk (HR 2.68 [CI 1.70-4.23]; p<0.001), which remained significant when controlling for biomarker elevations, irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. (p<0.01).
Conclusions:
Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.