Heart ultrasounds show right side cardiac strain may be strongly associated within-hospital COVID-19 deaths
May 18, 2020 —
Cardiologists at Mount Sinai Heart have demonstrated that hospitalized COVID-19 patients with right ventricular dilation (detected on an echocardiogram, or heart ultrasound) may be at a higher risk of unfavorable outcomes and mortality. Right ventricular dilation is when the right side of the heart enlarges and does not function efficiently, which can lead to heart failure. The reason behind the association with COVID-19 deaths remains unknown. Researchers say this could be multi-factorial including possible clots, lung damage, low blood oxygen level, or heart damage.
Why this is important: In this study, researchers found right ventricular dilation is the most specific finding, or most important factor, associated with mortality among hospitalized COVID-19 patients. They say this is something clinicians should look for when treating COVID-19 patients in an ICU setting and this could be a strong indicator of which patients may be at the highest risk.
How the research was conducted and findings: Researchers analyzed records of 105 COVID-19 patients hospitalized at Mount Sinai Morningside between March 26 and April 22. All of these patients received echocardiograms. Average age was 66 years old; 38 patients were female, and 31 patients were ventilated at the time of echocardiographic examination. Of all patients, 32 (31 percent) had right ventricular dilation based on their scans, and did not have significant differences in the prevalence of major comorbidities (hypertension, diabetes, and known coronary artery disease), laboratory markers of inflammation (white blood cell count, C-reactive protein) or myocardial injury. At the end of the study period 21 patients (20 percent) had died: 13 (41 percent) deaths were observed in patients with right ventricular dilation and 8 (11 percent) in patients without right ventricular dilation. The team of researchers observed right ventricular enlargement was the only variable significantly associated with mortality.
Conclusions: Right ventricular dilation is strongly associated with in-hospital mortality among the group of patients in this study. The mechanism heading to right ventricular dilation is likely multifactorial, and includes thrombotic events, hypoxemic vasoconstriction, cytokine milieu, and direct viral damage.
What this means for clinicians: Echocardiography (heart ultrasound) may provide important information regarding prognosis in patients hospitalized with COVID-19 infection.
“This study provides important evidence associating right heart strain with adverse outcomes in hospitalized patients with COVID-19 infection. Echocardiography is a readily available bedside tool that yields essential diagnostic and prognostic information in these patients,” explains Dr. Argulian. “Clinicians can use bedside echocardiography as a readily available tool to identify patients with COVID-19 infection at the highest risk of adverse hospital outcomes.”
Right Ventricular Dilation in Hospitalized Patients with COVID-19 Infection
Edgar Argulian, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai
Jagat Narula, MD, PhD, Associate Dean of Global Affairs and Philip J. and Harriet L. Goodhart Professor of Medicine (Cardiology), and Professor of Radiology, at the Icahn School of Medicine at Mount Sinai
Journal of the American College of Cardiology: Cardiovascular Imaging
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