Damage to heart's right ventricle predicts a greater chance
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When a patient is hospitalized with COVID-19, signs of damage to the right side of the heart may indicate a greater risk of death, according to a study from investigators at Weill Cornell Medicine and New York-Presbyterian. The findings suggest that physicians should consider looking for such damage using a readily available and non-invasive ultrasound test called an echocardiogram.

Doctors commonly assess lung X-rays, medical history, blood-oxygen levels, blood markers of inflammation and other indicators to determine which incoming COVID-19 patients are most at risk of developing severe disease. In a study of 510 patients, published in the Journal of the American College of Cardiology, the investigators found that signs of damage to the heart's right ventricle on an echocardiogram are another strong and independent predictor of severe disease. Patients who had signs of impaired right ventricle pumping capacity were on average two and a half times more likely to die from COVID-19 during their hospitalization.

The researchers analyzed diagnostic and prognostic tests, and clinical outcomes, for a series of 510 consecutive COVID-19 patients, covering multiple ethnicities, who were admitted and received echocardiograms. The median age of the patients was 64, and two-thirds were male.

Investigators found that patients with a standard sign of right ventricle damage, the expansion or "dilation," of the pumping chamber, were 1.43 times as likely to die during initial hospitalization for COVID-19. Patients whose right ventricles showed significantly below-normal contraction while pumping—a condition called "right ventricular dysfunction"—were nearly 3-fold as likely to die. These two heart signs were relatively common in the patients, being present in 35 percent and 15 percent, respectively.

In the researchers' analysis, no other standard marker of severe COVID-19 risk predicted mortality as strongly as right ventricular dysfunction.

"A big question was whether these right ventricular findings were independent predictors of mortality, or whether they were secondary markers of other prognostic factors, and it turns out they are strong and independent predictors," researchers said.

The findings support wider use of cardiovascular imaging to assess the risk of severe COVID-19 and to tailor patient care accordingly, the researchers concluded.

Source: https://www.sciencedirect.com/science/article/pii/S0735109720365505?via=ihub