Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS
| Autor: | Maria Vargas, Patrizia Murino, Giuseppe Fiorentino, Raffaele Verde, Robert Naeije, Emanuele Romeo, Ivan Gentile, Francesca M. Stagnaro, Antonio Cittadini, Giuseppe Servillo, Paolo Golino, Alberto M. Marra, Andrea Farro, Sergio Severino, Gianpiero Pagnano, Michele D'Alto, Giovanni Ciccarelli, Antonio Corcione, Andrea Salzano, Rosanna De Rosa |
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| Přispěvatelé: | D'Alto, M., Marra, A. M., Severino, S., Salzano, A., Romeo, E., De Rosa, R., Stagnaro, F. M., Pagnano, G., Verde, R., Murino, P., Farro, A., Ciccarelli, G., Vargas, M., Fiorentino, G., Servillo, G., Gentile, I., Corcione, A., Cittadini, A., Naeije, R., Golino, P. |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty ARDS Coronavirus disease 2019 (COVID-19) Prognosi Ventricular Dysfunction Right 030204 cardiovascular system & hematology Overweight Pulmonary Artery Critical Care and Intensive Care Medicine Right ventricular-arterial uncoupling 03 medical and health sciences 0302 clinical medicine Right heart failure Physiologie générale Internal medicine medicine.artery medicine Prevalence Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Aged Heart Failure Respiratory Distress Syndrome Ventricular function business.industry SARS-CoV-2 Research lcsh:Medical emergencies. Critical care. Intensive care. First aid COVID-19 lcsh:RC86-88.9 Middle Aged medicine.disease Prognosis Prospective Studie Italy Echocardiography Heart failure Pulmonary artery Cardiology Female medicine.symptom business Human |
| Zdroj: | Critical Care, Vol 24, Iss 1, Pp 1-10 (2020) Critical care, 24 (1 Critical Care |
| Popis: | Aim: To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute Respiratory Distress Syndrome (ARDS). Methods: Ninety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio Results: The majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270 ± 104 vs. 117 ± 57 mmHg, p < 0.001). In the non-survivors, PASP was increased (42 ± 12 vs. 30 ± 7 mmHg, p < 0.001), while TAPSE was decreased (19 ± 4 vs. 25 ± 4 mm, p < 0.001). Accordingly, the TAPSE/PASP ratio was lower than in the survivors (0.51 ± 0.22 vs. 0.89 ± 0.29 mm/mmHg, p < 0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR: 0.026; 95%CI 0.01–0.579; p: 0.019) and PaO2/FIO2 (HR: 0.988; 95%CI 0.988–0.998; p: 0.018) ratios were the only independent predictors of mortality, with ROC-determined cutoff values of 159 mmHg and 0.635 mm/mmHg, respectively. Conclusions: COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19. SCOPUS: ar.j info:eu-repo/semantics/published |
| Databáze: | OpenAIRE |
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