key: cord-0684174-ngkdd39k
authors: Dandel, Michael
title: Pathophysiology of COVID-19-associated acute respiratory distress syndrome
date: 2020-11-13
journal: Lancet Respir Med
DOI: 10.1016/s2213-2600(20)30507-5
sha: 306c4db007b9ef1dda107988958c546376815306
doc_id: 684174
cord_uid: ngkdd39k

nan

. These observations strongly indicate that pulmonary vascular thrombosis can be the main cause of COVID-19-related death. In this regard, it would be particularly important to have information on pulmonary arterial pressure and right-sided heart anatomy and function because, due to the direct alterations and damages of the pulmonary circulation, the pathophysiological role of the heart-lung interactions will become mainly involved in the development and progression of life-threatening right ventricular dysfunction.

Echocardiography has revealed elevated pulmonary arterial pressure in nearly 70% of patients with COVID-19. 3 In one study, right ventricular dilation was present in 31% of hospitalised patients and on multivariate analysis, right ventricular dilation was the only variable associated with mortality. 4 In heart-trans planted patients with COVID-19 who needed mechanical ventilation, the high mortality (up to 87%) appeared mainly associated with increased pulmonary arterial pressure and right ventricular dysfunction, whereas no patient showed left ventricular dysfunction. 5 Putting together all the information regarding D-dimers, respiratory system compliance, pulmonary hypoperfusion, pulmonary arterial pressure, and rightsided heart dilation and dysfunction leads to the conclusion that these aspects, and particularly the often neglected right ventricular, need more attention. Hand-held laptopbased echocardiography devices, which can be sufficient for assessment of right-sided heart alterations and dysfunction, could substantially improve the management of patients with symptomatic COVID-19 to reduce the particularly high mortality rates. I declare no competing interests.

German Centre for Heart and Circulatory Research (DZHK) Partner Site Berlin, Berlin 107085, Germany

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Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study

Critical care ultrasonography during COVID-19 pandemic: the ORACLE protocol

Right ventricular dilation in hospitalized patients with COVID-19 infection

COVID-19 among heart transplant recipients in Germany: a multicenter survey