Reply to: RV dysfunction in Covid-19 ARDS: Is there a difference in the impact of mechanical ventilation and ECMO?
| Autor: | Suveer Singh, Antonio de Marvao, Antonio Cannatà, Emmanouil Androulakis, Caroline Bleakley, Marco Morosin, Susanna Price |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty ARDS 2019-20 coronavirus outbreak Coronavirus disease 2019 (COVID-19) Critical Illness Ventricular Dysfunction Right medicine.medical_treatment Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Cohort Studies medicine Extracorporeal membrane oxygenation Humans Intensive care medicine Letter to the Editor Retrospective Studies Mechanical ventilation business.industry COVID-19 Middle Aged medicine.disease Echocardiography Critical illness Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | International Journal of Cardiology |
| ISSN: | 0167-5273 |
| Popis: | Comprehensive echocardiography assessment of right ventricular (RV) impairment has not been reported in critically ill patients with COVID-19. We detail the specific phenotype and clinical associations of RV impairment in COVID-19 acute respiratory distress syndrome (ARDS).Transthoracic echocardiography (TTE) measures of RV function were collected in critically unwell patients for associations with clinical, ventilatory and laboratory data.Ninety patients (25.6% female), mean age 52.0 ± 10.8 years, veno-venous extracorporeal membrane oxygenation (VVECMO) (42.2%) were studied. A significantly higher proportion of patients were identified as having RV dysfunction by RV fractional area change (FAC) (72.0%,95% confidence interval (CI) 61.0-81.0) and RV velocity time integral (VTI) (86.4%, 95 CI 77.3-93.2) than by tricuspid annular plane systolic excursion (TAPSE) (23.8%, 95 CI 16.0-33.9), RVS' (11.9%, 95% CI 6.6-20.5) or RV free wall strain (FWS) (35.3%, 95% CI 23.6-49.0). RV VTI correlated strongly with RV FAC (p ≤ 0.01). Multivariate regression demonstrated independent associations of RV FAC with NTpro-BNP and PVR. RV-PA coupling correlated with PVR (univariate p 0.01), as well as RVEDAi (p 0.01), and RVESAi (p 0.01), and was associated with P/F ratio (p 0.026), PEEP (p 0.025), and ALT (p 0.028).Severe COVID-19 ARDS is associated with a specific phenotype of RV radial impairment with sparing of longitudinal function. Clinicians should avoid interpretation of RV health purely on long-axis parameters in these patients. RV-PA coupling potentially provides important additional information above standard measures of RV performance in this cohort. |
| Databáze: | OpenAIRE |
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