Echocardiographic assessment of right ventricular performance in COVID-19 related acute respiratory distress syndrome: the importance of systo-diastolic interaction.

Autor: Dammassa V; Department of Experimental Medicine, University of Pavia, Pavia, Italy.; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK., Colombo CNJ; Department of Experimental Medicine, University of Pavia, Pavia, Italy.; Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Erba M; Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Ciarrocchi F; Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Pagani M; Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Price S; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.; National Heart and Lung Institute, Imperial College, London, UK., Mojoli F; Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy., Tavazzi G; Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. gtavazzi@yahoo.it.; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy. gtavazzi@yahoo.it.
Jazyk: angličtina
Zdroj: The ultrasound journal [Ultrasound J] 2024 May 07; Vol. 16 (1), pp. 26. Date of Electronic Publication: 2024 May 07.
DOI: 10.1186/s13089-024-00366-5
Abstrakt: Background: The cardiac manifestations of COVID-19 have been described in patients with acute respiratory distress syndrome (ARDS) admitted to intensive care unit (ICU). The presence and impact of right ventricular (RV) diastolic function and performance has not been studied in this population yet. We describe the prevalence of RV diastolic dysfunction, assessed by the pulmonary valve pre-ejection A wave (PV A wave), and the RV systo-diastolic interaction, using the RV total isovolumic time (t-IVT), in COVID-19 ARDS.
Results: Prospective observational study enrolling patients with moderate to severe COVID-19 ARDS admitted to ICU who underwent a transthoracic echocardiogram within 24 h of ICU admission and at least a second one during the ICU stay. Respiratory, hemodynamic and biochemistry parameters were collected. 163 patients (age 61.0 ± 9.3 years, 72% males) were enrolled. 36 patients (22.1%) had RV dysfunction, 45 (27.1%) LV systolic dysfunction. 73 patients (44.7%) had PV A wave. The RV t-IVT correlated with TAPSE at ICU admission (p < 0.002; r - 0.61), presence of PV A wave (p < 0.001; r 0.78), peak inspiratory pressure (PIP) (p < 0.001; r 0.42), PEEP (p < 0.001; r 0.68), dynamic driving pressure (DDP) (p < 0.001; r 0.58), and PaO 2 /FiO 2 ratio (p < 0.01; r - 0.35). The presence of PV A wave was associated with higher PIP (p < 0.001; r 0.45), higher PEEP (p < 0.001; r 0.56), higher DDP (p < 0.01, r 0.51), and lower PaO 2 /FiO 2 ratio (p < 0.001; r - 0.49).
Conclusions: RV t-IVT and the presence of PV A wave are non-invasive means to describe a significant RV diastolic dysfunction and may be consider descriptive signs of RV performance in COVID-19 ARDS.
(© 2024. The Author(s).)
Databáze: MEDLINE
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