The following is a summary of “Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up,” published in the January 2024 issue of Critical Care by Jozwiak et al. 

Researchers performed a retrospective study investigating the prevalence and evolution of right ventricular (RV) injury among ICU patients throughout their stay.

They conducted a bicentric study with standardized transthoracic echocardiographic (TTE) follow-up throughout the ICU stay, with a maximum follow-up of 28 days. Various RV injury patterns were identified, including isolated RV dilation, RV dysfunction (tricuspid annular plane systolic excursion < 17 mm and/or systolic tricuspid annular velocity < 9.5 cm/s and/or RV fractional area change < 35%) without RV dilation, RV dysfunction with RV dilation, and acute cor pulmonale (ACP, RV dilatation with paradoxical septal motion). With detailed RV injury patterns, link to Day-28 mortality was explored.

The results showed 118 patients with complete echocardiographic follow-up undergoing 393 TTE examinations during ICU stay, 73 (62%) exhibited at least one RV injury pattern in one or more TTE examinations, 29 (40%) with isolated RV dilation, 39 (53%) with RV dysfunction without RV dilation, 10 (14%) with RV dysfunction and RV dilation, and 2 (3%) with ACP. Patients with RV injury had increased cardiovascular risk, intubation, norepinephrine use, and a higher Day-28 mortality rate (27 vs. 7%, P<0.01).RV injury occurred independently in 82% of cases, linked with 18% left ventricular systolic dysfunction, and 10% experienced various RV injury patterns during ICU stay. The incidence of de novo RV injury decreased over time, with no new cases after Day 14, regardless of the RV injury pattern. Furthermore, 20 (31%) patients without initial RV injury in the ICU developed it during their stay. The only association with Day-28 mortality was observed in cases of RV dysfunction with RV dilation or ACP (aHR = 3.18, 95% CI [1.16–8.74], P=0.03).

They concluded that while prevalent in COVID-19 ICU patients, early RV injury mostly remained isolated and wasn’t linked to 28-day mortality, suggesting other factors might be more crucial.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01248-8