key: cord-0696216-4sixsodu
authors: Li, Yuman; Li, He; Li, Meng; Zhang, Li; Xie, Mingxing
title: The prevalence, risk factors and outcome of cardiac dysfunction in hospitalized patients with COVID-19
date: 2020-08-07
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06205-0
sha: e8e98b60582802b557d35ca60a953981ec5ac28b
doc_id: 696216
cord_uid: 4sixsodu

nan

ventilation. 9 (5.7%) patients had biventricular dysfunction. Clinical and echocardiographic characteristics of patients with COVID-19 are shown in Supplementary Tables 1 and 2. Compared with patients without cardiac insufficiency,those with cardiac insufficiency had more comorbidities and complications as well as poorer prognosis. A multivariate logistic regression analysis revealed that acute respiratory distress syndrome (ARDS) was independently predictive of cardiac dysfunction (Supplementary Table 3 ), which contributed to higher mortality (Fig. 1a) . Moreover, LV and RV dysfunction were more frequent in patients with elevated high-sensitivity troponin I (hs-TNI) than those without (Fig. 1b) . During hospitalization, 23 patients died. The incidence of LV and RV dysfunction were higher in non-survivors than survivors (Fig. 1c) . The mortality was 3.0% for patients without cardiac dysfunction and normal hs-TNI levels, 6.7% for those with cardiac dysfunction and normal hs-TNI levels, 13.3% for those without cardiac dysfunction but elevated hs-TNI levels, and 64.0% for those with cardiac dysfunction and elevated hs-TNI (Fig. 1d, e) . In multivariate Cox analysis, hs-TNI elevation, mechanical ventilation and RV dysfunction were independent predictors of higher mortality (Supplementary Table 4 ).

Our study demonstrated that the prevalence of RV dysfunction was higher than that of LV dysfunction in patients with COVID-19. Direct viral damage, aggravation of a systemic inflammatory response, and hypoxemia may all contribute to cardiac injury. Furthermore, RV function can be worsened by increased afterload, which are likely involve ARDS, hypoxic pulmonary vasoconstriction, microthrombi within the pulmonary vasculature and microvascular injury [4, 5] . Additionally, our findings revealed that mortality was highest in patients with increased troponin associated with RV dysfunction. Elevations of cardiac troponin and RV dysfunction were independently predictive of higher mortality, highlighting the significance of closely monitoring the changes of cardiac troponin and RV function. In summary, elevated cardiac troponin together with RV dysfunction may be crucial for risk stratification of COVID-19 patients and should be taken into consideration when applying prevention and therapy.

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