| Title | |
| Publication Type | Journal Article |
| Year of Publication | 2020 |
| Authors | Kim J, Volodarskiy A, Sultana R, Pollie MP, Yum B, Nambiar L, Tafreshi R, Mitlak HW, RoyChoudhury A, Horn EM, Hriljac I, Narula N, Kim S, Ndhlovu L, Goyal P, Safford MM, Shaw L, Devereux RB, Weinsaft JW |
| Journal | J Am Coll Cardiol |
| Volume | 76 |
| Issue | 17 |
| Pagination | 1965-1977 |
| Date Published | 2020 10 27 |
| ISSN | 1558-3597 |
| Keywords | Aged, Aged, 80 and over, Betacoronavirus, Biomarkers, Cohort Studies, Coronavirus Infections, COVID-19, Echocardiography, Female, Heart, Humans, Male, Middle Aged, New York City, Pandemics, Pneumonia, Viral, Risk Assessment, SARS-CoV-2, Ventricular Remodeling |
| Abstract | BACKGROUND: Coronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain. OBJECTIVES: The purpose of this study was to test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification. METHODS: Consecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at 3 New York City hospitals were studied; images were analyzed by a central core laboratory blinded to clinical and biomarker data. RESULTS: In total, 510 patients (age 64 ± 14 years, 66% men) were studied; RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p = 0.007). During inpatient follow-up (median 20 days), 77% of patients had a study-related endpoint (death 32%, discharge 45%). RV dysfunction (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.49 to 4.43; p = 0.001) and dilation (HR: 1.43; 95% CI: 1.05 to 1.96; p = 0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR: 1.39; 95% CI: 1.01 to 1.90; p = 0.041). RV indices provided additional risk stratification beyond biomarker strata; risk for death was greatest among patients with adverse RV remodeling and positive biomarkers and was lesser among patients with isolated biomarker elevations (p ≤ 0.001). In multivariate analysis, adverse RV remodeling conferred a >2-fold increase in mortality risk, which remained significant (p < 0.01) when controlling for age and biomarker elevations; the predictive value of adverse RV remodeling was similar irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. CONCLUSIONS: Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment. |
| DOI | 10.1016/j.jacc.2020.08.066 |
| Alternate Journal | J Am Coll Cardiol |
| PubMed ID | 33092732 |
| PubMed Central ID | PMC7572068 |
| Grant List | K23 HL140092 / HL / NHLBI NIH HHS / United States R01 HL128278 / HL / NHLBI NIH HHS / United States |