Right ventricular (RV) dilation was prevalent in a small retrospective study of 105 patients hospitalized at Mount Sinai Morningside Hospital, New York, NY, due to COVID-19 between March 26 and April 22. The results, published in JACC: Cardiovascular Imaging, suggest "the mechanism of right ventricular dilation is likely multifactorial" and "strongly associated with in-hospital mortality."

Edgar Argulian, MD, MPH, FACC, et al., used a focused, time-efficient echocardiography protocol involving portable ultrasound machines, physician interpretation of echocardiograms, and univariate and multivariate regression analysis. The mean age of the patients was 66 years and 36% were female. According to the authors, 30% of patients were intubated and mechanically ventilated at the time echocardiography took place.

Overall, RV dilation was present in 31% of patients. While Argulian and colleagues did not observe any significant differences in the prevalence of major comorbidities, laboratory markers of inflammation or myocardial injury in these patients, they noted a higher likelihood of renal dysfunction. RV hypokinesis (66% vs. 5%; p=0.01) and moderate or severe tricuspid regurgitation (21% vs. 7%; p=0.05) were also more prevalent compared with patients without RV enlargement. There were no differences between patients with or without RV dilation in the use of therapeutic anticoagulation at the time of the echocardiography exam and in the measures of left ventricular size and function.

In terms of mortality, 21 patients had died at the end of the study period. Of these, 13 (41%) had RV dilation. According to the authors, mechanical ventilation, vasoactive medication use, and RV enlargement were significantly associated with mortality.

"This is a small study," said ACC.org Editor-in-Chief Kim A. Eagle, MD, MACC. "However, it does add to the growing body of research surrounding how to identify and mitigate cardiovascular risks in COVID-19 patients."

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Echocardiography/Ultrasound

Keywords: Retrospective Studies, Prevalence, Tricuspid Valve Insufficiency, Respiration, Artificial, Hospital Mortality, Dilatation, COVID-19, Risk Factors, severe acute respiratory syndrome coronavirus 2, Hypertrophy, Right Ventricular, Echocardiography, Ultrasonography

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