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Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection

BACKGROUND: The COVID‐19–related pulmonary effects may negatively impact pulmonary hemodynamics and right ventricular function. We examined the prognostic relevance of right ventricular function and right ventricular‐to‐pulmonary circulation coupling assessed by bedside echocardiography in patients...

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Autores principales: Bursi, Francesca, Santangelo, Gloria, Barbieri, Andrea, Vella, Anna Maria, Toriello, Filippo, Valli, Federica, Sansalone, Dario, Carugo, Stefano, Guazzi, Marco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245834/
https://www.ncbi.nlm.nih.gov/pubmed/35156389
http://dx.doi.org/10.1161/JAHA.121.023220
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author Bursi, Francesca
Santangelo, Gloria
Barbieri, Andrea
Vella, Anna Maria
Toriello, Filippo
Valli, Federica
Sansalone, Dario
Carugo, Stefano
Guazzi, Marco
author_facet Bursi, Francesca
Santangelo, Gloria
Barbieri, Andrea
Vella, Anna Maria
Toriello, Filippo
Valli, Federica
Sansalone, Dario
Carugo, Stefano
Guazzi, Marco
author_sort Bursi, Francesca
collection PubMed
description BACKGROUND: The COVID‐19–related pulmonary effects may negatively impact pulmonary hemodynamics and right ventricular function. We examined the prognostic relevance of right ventricular function and right ventricular‐to‐pulmonary circulation coupling assessed by bedside echocardiography in patients hospitalized with COVID‐19 pneumonia and a large spectrum of disease independently of indices of pneumonia severity and left ventricular function. METHODS AND RESULTS: Consecutive COVID‐19 subjects who underwent full cardiac echocardiographic evaluation along with gas analyses and computed tomography scans were included in the study. Measurements were performed offline, and quantitative analyses were obtained by an operator blinded to the clinical data. We analyzed 133 patients (mean age 69±12 years, 57% men). During a mean hospital stay of 26±16 days, 35 patients (26%) died. The mean tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was 0.48±0.18 mm/Hg in nonsurvivors and 0.72±0.32 mm/Hg in survivors (P=0.002). For each 0.1 mm/mm Hg increase in TAPSE/PASP, there was a 27% lower risk of in‐hospital death (hazard ratio [HR], 0.73 [95% CI, 0.59–0.89]; P=0.003). At multivariable analysis, TAPSE/PASP ratio remained a predictor of in‐hospital death after adjustments for age, oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen, left ventricular ejection fraction, and computed tomography lung score. Receiver operating characteristic analysis was used to identify the cutoff value of the TAPSE/PASP ratio, which best specified high‐risk from lower‐risk patients. The best cutoff for predicting in‐hospital mortality was TAPSE/PASP <0.57 mm/mm Hg (75% sensitivity and 70% specificity) and was associated with a >4‐fold increased risk of in‐hospital death (HR, 4.8 [95% CI, 1.7–13.1]; P=0.007). CONCLUSIONS: In patients hospitalized with COVID‐19 pneumonia, the assessment of right ventricular to pulmonary circulation coupling appears central to disease evolution and prediction of events. TAPSE/PASP ratio plays a mainstay role as prognostic determinant beyond markers of lung injury.
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spelling pubmed-92458342022-07-01 Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection Bursi, Francesca Santangelo, Gloria Barbieri, Andrea Vella, Anna Maria Toriello, Filippo Valli, Federica Sansalone, Dario Carugo, Stefano Guazzi, Marco J Am Heart Assoc Original Research BACKGROUND: The COVID‐19–related pulmonary effects may negatively impact pulmonary hemodynamics and right ventricular function. We examined the prognostic relevance of right ventricular function and right ventricular‐to‐pulmonary circulation coupling assessed by bedside echocardiography in patients hospitalized with COVID‐19 pneumonia and a large spectrum of disease independently of indices of pneumonia severity and left ventricular function. METHODS AND RESULTS: Consecutive COVID‐19 subjects who underwent full cardiac echocardiographic evaluation along with gas analyses and computed tomography scans were included in the study. Measurements were performed offline, and quantitative analyses were obtained by an operator blinded to the clinical data. We analyzed 133 patients (mean age 69±12 years, 57% men). During a mean hospital stay of 26±16 days, 35 patients (26%) died. The mean tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was 0.48±0.18 mm/Hg in nonsurvivors and 0.72±0.32 mm/Hg in survivors (P=0.002). For each 0.1 mm/mm Hg increase in TAPSE/PASP, there was a 27% lower risk of in‐hospital death (hazard ratio [HR], 0.73 [95% CI, 0.59–0.89]; P=0.003). At multivariable analysis, TAPSE/PASP ratio remained a predictor of in‐hospital death after adjustments for age, oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen, left ventricular ejection fraction, and computed tomography lung score. Receiver operating characteristic analysis was used to identify the cutoff value of the TAPSE/PASP ratio, which best specified high‐risk from lower‐risk patients. The best cutoff for predicting in‐hospital mortality was TAPSE/PASP <0.57 mm/mm Hg (75% sensitivity and 70% specificity) and was associated with a >4‐fold increased risk of in‐hospital death (HR, 4.8 [95% CI, 1.7–13.1]; P=0.007). CONCLUSIONS: In patients hospitalized with COVID‐19 pneumonia, the assessment of right ventricular to pulmonary circulation coupling appears central to disease evolution and prediction of events. TAPSE/PASP ratio plays a mainstay role as prognostic determinant beyond markers of lung injury. John Wiley and Sons Inc. 2022-02-12 /pmc/articles/PMC9245834/ /pubmed/35156389 http://dx.doi.org/10.1161/JAHA.121.023220 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Bursi, Francesca
Santangelo, Gloria
Barbieri, Andrea
Vella, Anna Maria
Toriello, Filippo
Valli, Federica
Sansalone, Dario
Carugo, Stefano
Guazzi, Marco
Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection
title Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection
title_full Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection
title_fullStr Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection
title_full_unstemmed Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection
title_short Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection
title_sort impact of right ventricular‐pulmonary circulation coupling on mortality in sars‐cov‐2 infection
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245834/
https://www.ncbi.nlm.nih.gov/pubmed/35156389
http://dx.doi.org/10.1161/JAHA.121.023220
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