key: cord-0741546-oh497rz9
authors: Gonzalez-Fernandez, Oscar; Antonio, Ines Ponz De; Rodriguez, Sandra O. Rosillo; Cantador, Jose Ruiz; Iglesias, Juan C. Figueira; Hentschel, Jose L. Lopez-Sendon
title: D-dimer and right ventricular abnormalities as prognostic factors in critically ill COVID-19 patients
date: 2020-07-16
journal: Rev Esp Cardiol (Engl Ed)
DOI: 10.1016/j.rec.2020.07.004
sha: be1ddc09dbff38c46543abc05291e1e0ef421e7a
doc_id: 741546
cord_uid: oh497rz9

nan

Oscar GONZALEZ-FERNANDEZ, a,*,◊ Ines PONZ DE ANTONIO, a,◊ Sandra O. ROSILLO 

Coronavirus disease 2019 (COVID-19) seems to be associated with a higher risk of myocardial injury, especially in critically ill patients. 1 Previous definitions of acute COVID-19 cardiovascular syndrome 2 have been heterogeneous, and therefore its true incidence, clinical relevance and prognostic impact remain unclear. The aim of this study was to analyze echocardiographic abnormalities and biomarkers in COVID-19 patients requiring intensive care and their association with 30-day survival.

Observational, prospective cohort study of patients admitted to the intensive care unit (ICU) of 59 450] ng/mL; P = .01) compared with those with a normal RV. In contrast, median hs-TnI was not associated with a higher incidence of cardiac structural abnormalities. No differences were found between positive end-expiratory pressure and RV function or dimension.

Kaplan-Meier survival analyses were performed for all patients. Survival at 30 days was significantly lower in patients with higher D-dimer values than the median (figure 1). Lower 30-day survival rates were also found in patients with RV dysfunction and dilatation.

A multivariate Cox-proportional hazards regression analysis was performed including age, D-dimer values, and RV dysfunction. RV function was identified as an independent predictor of 30-day survival in our cohort (hazard ratio, 3.71; 95% confidence interval, 1.28-10-76; P = .02).

The major cardiovascular events rate was relatively low in our cohort. PE occurred in 3 patients, who These findings may be related to an increased prevalence of PE in COVID-19 patients. Nevertheless, in the ICU scenario, patients with acute respiratory distress syndrome requiring mechanical ventilation may also develop acute cor pulmonale, which may be indistinguishable. Surprisingly, the high positive end-expiratory pressure levels shown in our population did not correlate with RV abnormalities. Therefore, a hypothesis of a pulmonary prothrombotic state impacting on the RV should be raised and might be related to worse outcomes. Our data are consistent with autopsy reports 5 and computed tomography scans 6 of COVID-19 patients, showing RV dilatation and multiple thrombi in small pulmonary vessels.

Because our study is a single-center experience with a small sample size, it has some limitations. The main limitation is that we did not perform computed tomography due to the patients' critical status and isolation protocols. Further research is needed to confirm our findings.

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan

Description and propose management of Acute COVID-19 Cardiovascular Syndrome

COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel

ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak

Vander Heide RS. Pulmonary and Cardiac Pathology in Covid-19

Incidence of thrombotic complications in critically ill ICU patients with COVID-19

survival curves representing cumulative survival at 30 days by A: peak D-dimer values (considering a median value of 16 250 ng/mL); B: right ventricular function; and C: right ventricular dimension. RV

RVF, right ventricular function