Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes
| Autor: | Naomi C. Chesler, Joanna Eva Kusmirek, Aurangzeb Baber, James R. Runo, Christopher J. François, Nizar N. Jarjour, Sofia Carolina Masri, Marlowe W. Eldridge, Farhan Raza, Ravi Dhingra, Roderick C. Deaño, Ran Tao, Zuzana Burivalova, Naga Dharmavaram, Rebecca Vanderpool, Timothy Hess |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19) Adverse outcomes business.industry Right ventricular dilation Chest CT-angiogram Clinical Trials and Supportive Activities Chest ct COVID-19 Pneumonia Cardiovascular Text mining Infectious Diseases Clinical Research Pneumonia & Influenza Medicine LV ratio [RV] Biomedical Imaging Radiology business Lung |
| Zdroj: | The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, vol 74, iss 1 |
| Popis: | Background Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease. Results We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1. Conclusions In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs. |
| Databáze: | OpenAIRE |
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