Right ventricular dysfunction in patients with COVID-19 pneumonitis whose lungs are mechanically ventilated: a multicentre prospective cohort study

McCall, P.J. , Willder, J.M., Stanley, B.L. , Messow, C.-M. , Allan, J., Gemmell, L., Puxty, A., Strachan, D., Berry, C. and Shelley, B.G. (2022) Right ventricular dysfunction in patients with COVID-19 pneumonitis whose lungs are mechanically ventilated: a multicentre prospective cohort study. Anaesthesia, 77(7), pp. 772-784. (doi: 10.1111/anae.15745) (PMID:35607911)

[img] Text
269004.pdf - Published Version
Available under License Creative Commons Attribution.

549kB

Abstract

Cardiovascular complications due to COVID-19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID-19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high-sensitivity troponin and N-terminal pro B-type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3–13%). Thirty-day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p < 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N-terminal pro B-type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology.

Item Type:Articles
Additional Information:This work was supported by Medical Research Scotland (CVG-1730-2020). BS is supported by the National Institute of Academic Anaesthesia and Royal College of Anaesthetists British Oxygen Company Chair of Anaesthesia Research Grant. CB receives research funding from the British Heart Foundation grant (RE/18/6134217), Chief Scientist Office, EPSRC (EP/R511705/1, EP/S030875/1), European Union (754946-2), Medical Research Council (MR/S018905/1) and UKRI (MC/PC/20014).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Stanley, Miss Bethany and Shelley, Dr Benjamin and Puxty, Dr Alex and Berry, Professor Colin and Messow, Dr Martina and McCall, Dr Philip
Authors: McCall, P.J., Willder, J.M., Stanley, B.L., Messow, C.-M., Allan, J., Gemmell, L., Puxty, A., Strachan, D., Berry, C., and Shelley, B.G.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Anaesthesia
Publisher:Wiley
ISSN:0003-2409
ISSN (Online):1365-2044
Published Online:24 May 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Anaesthesia 77(7): 772-784
Publisher Policy:Reproduced under a Creative Commons license

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
311395Right Ventricular Dysfunction in Ventilated Patients with COVID-19 (COVID-RV)Benjamin ShelleyMedical Research Scotland (MEDRESSC)CVG-1730-2020HW - Robertson Centre
300137Impact Acceleration Account - University of Glasgow 2017Jonathan CooperEngineering and Physical Sciences Research Council (EPSRC)EP/R511705/1Research and Innovation Services
303232EPSRC Centre for Multiscale soft tissue mechanics with MIT and POLIMI (SofTMech-MP)Xiaoyu LuoEngineering and Physical Sciences Research Council (EPSRC)EP/S030875/1M&S - Mathematics
303684A randomized, double-blind, placebo-controlled Phase 2A cross-over trial of oral zibotentan in patients with angina due to small vessel disease: a proof-of-concept, developmental trial for safety, efficacy and biomarkers developmentColin BerryMedical Research Council (MRC)MR/S018905/1CAMS - Cardiovascular Science