Tao Ran, Burivalova Zuzana, Masri S Carolina, Dharmavaram Naga, Baber Aurangzeb, Deaño Roderick, Hess Timothy, Dhingra Ravi, Runo James, Jarjour Nizar, Vanderpool Rebecca R, Chesler Naomi, Kusmirek Joanna E, Eldridge Marlowe, Francois Christopher, Raza Farhan
Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Nelson Institute for Environmental Studies, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
Egypt Heart J. 2022 May 8;74(1):37. doi: 10.1186/s43044-022-00274-w.
Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease.
We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1.
In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.
右心室（RV）扩张已被用于预测急性肺部疾病的不良预后。它也被用于对新型冠状病毒感染（COVID-19）的严重程度进行分类。我们的研究旨在利用胸部CT血管造影（CTA）来评估右心室扩张增加（以右心室与左心室（LV）的比值增加来量化）是否与COVID-19感染的不良预后相关，以及它的发生是否与肺实质疾病不成比例。
我们回顾了COVID-19患者（n = 100）以及两个对照组（正常受试者（n = 10）和机化性肺炎患者（n = 10））的临床、实验室和胸部CTA检查结果。在胸部CTA上，我们在聚焦的四腔视图中测量右心室和左心室的基底尺寸，以及肺动脉（PA）分叉水平处的肺动脉（PA）和主动脉（AO）的尺寸。在COVID-19队列中，较高的右心室与左心室比值与不良预后相关，不良预后定义为入住重症监护病房、插管或死亡。在有不良预后的患者中，右心室与左心室比值为1.06±0.10，而在无不良预后的患者中为0.95±0.15。在不良预后组中，与机化性肺炎对照组相比，肺实质损伤较轻（22.6±9.0对32.7±6.6），但右心室与左心室比值较高（1.06±0.14对0.89±0.07）。在ROC分析中，右心室与左心室比值的曲线下面积（AUC）= 0.707，最佳截断值为右心室与左心室≥1.1作为不良预后的预测指标。在一个验证队列（n = 25）中，以右心室与左心室≥1.1为截断值预测不良预后的比值比为76:1。
在COVID-19患者中，胸部CT上右心室与左心室比值≥1.1与不良预后相关。COVID-19中的右心室扩张与肺实质损伤不成比例，提示肺部存在血管和/或血栓形成性损伤。
