新型冠状病毒肺炎中的右心室功能障碍与肺动脉高压：患病率及其与临床结局关联的荟萃分析

Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome.

作者信息

Oktaviono Yudi Her, Mulia Eka Prasetya Budi, Luke Kevin, Nugraha David, Maghfirah Irma, Subagjo Agus

机构信息

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia.

Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

出版信息

Arch Med Sci. 2021 May 5;18(5):1169-1180. doi: 10.5114/aoms/136342. eCollection 2022.

INTRODUCTION

Rapid spread of COVID-19 has caused detrimental effects globally. Involvement of the ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH), were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and their association with COVID-19 clinical outcome.

MATERIAL AND METHODS

A systematic data search was conducted through PubMed, medRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using RevMan v.5.4 and Stata v.16.

RESULTS

A total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95% CI: 13-25%), and PH was 22% (95% CI: 14-31%). RVD was associated with increased mortality (OR = 2.98 (95% CI: 1.50-5.89), = 0.002), severity (OR = 3.61 (95% CI: 2.05-6.35), < 0.001), ICU admission (OR = 1.70 (95% CI: 1.12-2.56), = 0.01), and mechanical ventilation (MV) usage (OR = 1.60 (95% CI: 1.14-2.25), = 0.007). PH was also associated with increased mortality (OR = 5.42 (95% CI: 2.66-11.060, < 0.001), severity (OR = 5.74 (95% CI: 2.28-14.49), < 0.001), and ICU admission (OR = 12.83 (95% CI: 3.55-46.41), < 0.001).

CONCLUSIONS

RVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.

引言

新型冠状病毒肺炎（COVID-19）的迅速传播已在全球范围内造成有害影响。血管紧张素转换酶2（ACE2）受体的参与已将COVID-19确定为一种多器官疾病。初步研究已提供证据表明，在COVID-19病例中发现了心脏受累情况，包括右心室功能障碍（RVD）和肺动脉高压（PH），即使在疾病非晚期阶段也是如此。本荟萃分析旨在分析RVD和PH的患病率及其与COVID-19临床结局的关联。

材料与方法

通过PubMed、medRxiv、ProQuest、ScienceDirect和Scopus数据库，使用基于医学主题词表（MeSH）术语构建的关键词进行系统的数据检索。使用RevMan v.5.4和Stata v.16分析有关死亡率、严重程度、入住重症监护病房（ICU）和使用机械通气的任何结果。

结果

共纳入16项符合条件的研究（1728例患者）。COVID-19中RVD的合并患病率为19%（95%置信区间：13%-25%），PH为22%（95%置信区间：14%-31%）。RVD与死亡率增加相关（比值比[OR]=2.98（95%置信区间：1.50-5.89），P=0.002）、严重程度增加相关（OR=3.61（95%置信区间：2.05-6.35），P<0.001）、入住ICU相关（OR=1.70（95%置信区间：1.12-2.56），P=0.01）以及使用机械通气（MV）相关（OR=1.60（95%置信区间：1.14-2.25），P=0.007）。PH也与死亡率增加相关（OR=5.42（95%置信区间：2.66-11.06），P<0.001）、严重程度增加相关（OR=5.74（95%置信区间：2.28-14.49），P<0.001）以及入住ICU相关（OR=12.83（95%置信区间：3.55-46.41），P<0.001）。