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Objective: Right ventricular dysfunction (RVD) is common in the critically ill. To date studies exploring RVD sequelae have had heterogenous definitions and diagnostic methods, with limited follow-up. Additionally much literature has been pathology specific, limiting applicability to the general critically unwell patient. Method and Study Design: We conducted a systematic review and meta-analysis to evaluate the impact of RVD diagnosed with transthoracic echocardiography (TTE) on long-term mortality in unselected critically unwell patients compared to those without RVD. A systematic search of EMBASE, Medline and Cochrane was performed from inception to March 2022. All RVD definitions using TTE were included. Patients were those admitted to a critical or intensive care unit, irrespective of disease processes. Long-term mortality was defined as all-cause mortality occurring at least 30 days after hospital admission. A priori subgroup analyses included disease specific and delayed mortality (death after hospital discharge/after the 30th day from hospital admission) in patients with RVD. A random effects model analysis was performed with the Dersimionian and Laird inverse variance method to generate effect estimates. Results: Of 5985 studies, 123 underwent full text review with 16 included (n = 3196). 1258 patients had RVD. 19 unique RVD criteria were identified. The odds ratio (OR) for long term mortality with RVD was 2.92 (95% CI 1.92–4.54, I 2 76.4%) compared to no RVD. The direction and extent was similar for cardiac and COVID19 subgroups. Isolated RVD showed an increased risk of delayed mortality when compared to isolated left/biventricular dysfunction (OR 2.01, 95% CI 1.05–3.86, I 2 46.8%). Conclusion: RVD, irrespective of cause, is associated with increased long term mortality in the critically ill. Future studies should be aimed at understanding the pathophysiological mechanisms by which this occurs. Commonly used echocardiographic definitions of RVD show significant heterogeneity across studies, which contributes to uncertainty within this dataset. [ABSTRACT FROM AUTHOR]

Objective: To look for any relationship between severe/critical coronavirus disease 2019 (COVID-19) illness and post-discharge cardiac function, and also assess any correlation between this and post-COVID symptom burden. Design: Observational cohort study with both retrospective and prospective components. Setting: Intensive Care Unit (ICU) and subsequent outpatient clinic at a tertiary hospital in Western Sydney, New South Wales (NSW), Australia. Patients: All patients admitted to the ICU with COVID-19 infection between 01 July 2021 and 31 December 2021 were included (n=89). Interventions: The cohort was divided into survivors (n=61) and non-survivors (n=28). Those who underwent transthoracic echocardiography (TTE) (survivors, n=22; and non-survivors, n=23). The survivors who had an inpatient TTE were invited back for a repeat TTE and standardised symptom assessment questionnaire (COVID-19 Yorkshire Rehabilitation Scale [C19-YRS]). For all patients, demographic, clinical, biochemical, and pharmacologic data was collected. Measurements and results: Eighty-nine patients were included in the initial dataset, of which 45 had a TTE whilst acutely unwell, and 22/45 survived to hospital discharge. There were no significant differences in the measured TTE parameters between survivors and non-survivors. Of the survivors with a follow-up TTE, the majority of the changes seen in the initial study had resolved. Despite this, there was still an appreciable symptom burden in the domains of fatigue, breathlessness, ability to independently do activities of daily living, and overall reduced perception of health. Conclusions: In a cohort of critically unwell COVID-19 patients, there were no significant echocardiographic differences between survivors and non-survivors. For the survivors, whilst the majority of acute cardiac changes associated with COVID-19 infection resolved over time, however, there remained a significant symptom burden, including breathlessness and fatigability, suggesting a non-cardiac aetiology of these symptoms. [ABSTRACT FROM AUTHOR]