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Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS
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) adm...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703719/ https://www.ncbi.nlm.nih.gov/pubmed/33256813 http://dx.doi.org/10.1186/s13054-020-03385-5 |
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author | D’Alto, Michele Marra, Alberto M. Severino, Sergio Salzano, Andrea Romeo, Emanuele De Rosa, Rosanna Stagnaro, Francesca Maria Pagnano, Gianpiero Verde, Raffaele Murino, Patrizia Farro, Andrea Ciccarelli, Giovanni Vargas, Maria Fiorentino, Giuseppe Servillo, Giuseppe Gentile, Ivan Corcione, Antonio Cittadini, Antonio Naeije, Robert Golino, Paolo |
author_facet | D’Alto, Michele Marra, Alberto M. Severino, Sergio Salzano, Andrea Romeo, Emanuele De Rosa, Rosanna Stagnaro, Francesca Maria Pagnano, Gianpiero Verde, Raffaele Murino, Patrizia Farro, Andrea Ciccarelli, Giovanni Vargas, Maria Fiorentino, Giuseppe Servillo, Giuseppe Gentile, Ivan Corcione, Antonio Cittadini, Antonio Naeije, Robert Golino, Paolo |
author_sort | D’Alto, Michele |
collection | PubMed |
description | 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 (PaO(2))/fraction of inspired O(2) (FIO(2)) 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 PaO(2)/FIO(2) (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 PaO(2)/FIO(2) in ARDS on COVID-19. |
format | Online Article Text |
id | pubmed-7703719 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-77037192020-12-01 Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS D’Alto, Michele Marra, Alberto M. Severino, Sergio Salzano, Andrea Romeo, Emanuele De Rosa, Rosanna Stagnaro, Francesca Maria Pagnano, Gianpiero Verde, Raffaele Murino, Patrizia Farro, Andrea Ciccarelli, Giovanni Vargas, Maria Fiorentino, Giuseppe Servillo, Giuseppe Gentile, Ivan Corcione, Antonio Cittadini, Antonio Naeije, Robert Golino, Paolo Crit Care Research 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 (PaO(2))/fraction of inspired O(2) (FIO(2)) 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 PaO(2)/FIO(2) (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 PaO(2)/FIO(2) in ARDS on COVID-19. BioMed Central 2020-11-30 /pmc/articles/PMC7703719/ /pubmed/33256813 http://dx.doi.org/10.1186/s13054-020-03385-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research D’Alto, Michele Marra, Alberto M. Severino, Sergio Salzano, Andrea Romeo, Emanuele De Rosa, Rosanna Stagnaro, Francesca Maria Pagnano, Gianpiero Verde, Raffaele Murino, Patrizia Farro, Andrea Ciccarelli, Giovanni Vargas, Maria Fiorentino, Giuseppe Servillo, Giuseppe Gentile, Ivan Corcione, Antonio Cittadini, Antonio Naeije, Robert Golino, Paolo Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS |
title | Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS |
title_full | Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS |
title_fullStr | Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS |
title_full_unstemmed | Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS |
title_short | Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS |
title_sort | right ventricular-arterial uncoupling independently predicts survival in covid-19 ards |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703719/ https://www.ncbi.nlm.nih.gov/pubmed/33256813 http://dx.doi.org/10.1186/s13054-020-03385-5 |
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