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Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized with COVID-19 according to Race

Moody, WE; Mahmoud-Elsayed, HM; Senior, J; Gul, U; Khan-Kheil, AM; Horne, S; Banerjee, A; ... Steeds, RP; + view all (2020) Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized with COVID-19 according to Race. CJC Open 10.1016/j.cjco.2020.09.016. (In press). Green open access

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Abstract

Background: Epidemiological studies suggest that black, Asian and minority ethnic (BAME) patients may be at risk of worse outcomes from Coronavirus-19 (COVID-19) but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality and race in COVID-19 pneumonia. Methods: This was a multicenter, retrospective, observational study including 164 adults (61±13years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (IQR 2 - 5) from admission. The primary outcome was all-cause mortality. Results: After a median follow up of 31 days (IQR 14 - 42 days), 58 (35%) patients had died. The right ventricle (RV) was dilated in 62 (38%) patients, and 58 (35%) patients had RV systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = -0.18, p = 0.025) and high-sensitivity cardiac Troponin (ρ = -0.30, p < 0.0001). Reduced RV systolic function (HR, 1.80; 95% CI, 1.05 - 3.09; p = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers or mortality. Conclusions: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is however, no racial variation in the early findings on echocardiography, biomarkers or mortality.

Type: Article
Title: Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized with COVID-19 according to Race
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.cjco.2020.09.016
Publisher version: https://doi.org/10.1016/j.cjco.2020.09.016
Language: English
Additional information: This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. The images or other third party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: COVID-19, Cardiac Biomarkers, Doppler Echocardiography, Ethnicity, Right Ventricle
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10113640
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