Cardiac Intensive Care Unit, San Raffaele Scientific Institute, Milan, Italy
Cardiac Intensive Care Unit, San Raffaele Scientific Institute, Milan, Italy.
Heart. 2020 Sep;106(17):1324-1331. doi: 10.1136/heartjnl-2020-317355. Epub 2020 Jul 16.
To assess the prevalence, characteristics and prognostic value of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in hospitalised, non-intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).
This single-centre, observational, cross-sectional study included 211 patients with COVID-19 admitted to non-ICU departments who underwent a single transthoracic echocardiography (TTE). Patients with poor acoustic window (n=11) were excluded. Clinical, imaging, laboratory and TTE findings were compared in patients with versus without PH (estimated systolic pulmonary artery pressure >35 mm Hg) and with versus without RVD (tricuspid annular plane systolic excursion <17 mm or S wave <9.5 cm/s). The primary endpoint was in-hospital death or ICU admission.
A total of 200 patients were included in the final analysis (median age 62 (IQR 52-74) years, 65.5% men). The prevalence of PH and RVD was 12.0% (24/200) and 14.5% (29/200), respectively. Patients with PH were older and had a higher burden of pre-existing cardiac comorbidities and signs of more severe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (radiological lung involvement, laboratory findings and oxygenation status) compared with those without PH. Conversely, patients with RVD had a higher burden of pre-existing cardiac comorbidities but no evidence of more severe SARS-CoV-2 infection compared with those without RVD. The presence of PH was associated with a higher rate of in-hospital death or ICU admission (41.7 vs 8.5%, p<0.001), while the presence of RVD was not (17.2 vs 11.7%, p=0.404).
Among hospitalised non-ICU patients with COVID-19, PH (and not RVD) was associated with signs of more severe COVID-19 and with worse in-hospital clinical outcome.
NCT04318366.
评估 2019 年冠状病毒病（COVID-19）住院非重症监护病房（ICU）患者中肺动脉高压（PH）和右心功能障碍（RVD）的患病率、特征和预后价值。
这是一项单中心、观察性、横断面研究，纳入了 211 例在非 ICU 科室住院并接受单次经胸超声心动图（TTE）检查的 COVID-19 患者。排除了声学窗不佳的患者（n=11）。比较了有与无 PH（估计收缩期肺动脉压>35mmHg）以及有与无 RVD（三尖瓣环平面收缩期位移<17mm 或 S 波<9.5cm/s）患者的临床、影像学、实验室和 TTE 发现。主要终点是院内死亡或入住 ICU。
共纳入 200 例患者进行最终分析（中位年龄 62（IQR 52-74）岁，65.5%为男性）。PH 和 RVD 的患病率分别为 12.0%（24/200）和 14.5%（29/200）。与无 PH 患者相比，有 PH 的患者年龄更大，有更高的心脏合并症负担，以及更严重的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的体征（影像学肺受累、实验室发现和氧合状态）。相反，与无 RVD 患者相比，有 RVD 的患者有更高的心脏合并症负担，但没有证据表明 SARS-CoV-2 感染更严重。存在 PH 与更高的院内死亡或 ICU 入院率相关（41.7% vs 8.5%，p<0.001），而存在 RVD 则不然（17.2% vs 11.7%，p=0.404）。
在 COVID-19 住院非 ICU 患者中，PH（而非 RVD）与更严重的 COVID-19 体征以及更差的院内临床结局相关。
NCT04318366。
