Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

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.
This is the first study to assess the influence of race on echocardiographic findings in patients hospitalized with COVID-19 disease. In high-risk patients hospitalized with advanced COVID-19 disease, right ventricular (RV) dilatation and dysfunction are common; RV dysfunction (measured using the simple standard measures FAC and TAPSE) is independently associated with early mortality, and is associated with elevated D-dimer and high-sensitivity cardiac Troponin. There are, however, no racial differences in echocardiographic findings, biomarkers, or mortality.