AUTHOR=Beyls Christophe , Vial Jeremie , Lefebvre Thomas , Muller Charlotte , Hanquiez Thomas , Besserve Patricia , Guilbart Mathieu , Haye Guillaume , Bernasinski Michael , Huette Pierre , Dupont Hervé , Abou-Arab Osama , Jounieaux Vincent , Mahjoub Yazine 

TITLE=Prognostic value of right ventricular dilatation on computed tomography pulmonary angiogram for predicting adverse clinical events in severe COVID-19 pneumonia

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1213775

DOI=10.3389/fmed.2023.1213775

ISSN=2296-858X

ABSTRACT=Background: Right ventricle dilatation (RVD) is a common complication of non-intubated COVID-19 pneumonia caused by pro-thrombotic pneumonitis, intra-pulmonary shunting, and pulmonary vascular dysfunction. In several pulmonary diseases, RVD is routinely measured on computed tomography pulmonary angiogram (CTPA) by the right ventricle-to-left ventricle (LV) diameter ratio > 1 for predicting adverse events.The aim of the study was to evaluate the association between RVD and the occurrence of adverse events in a cohort of critically ill non-intubated COVID-19 patients.Methods: Between February 2020 and February 2022, non-intubated patients admitted to the Amiens University Hospital intensive care unit for COVID-19 pneumonia with CTPA performed within 48 hours of admission were included. RVD was defined by an RV/LV diameter ratio greater than one measured on CTPA. The primary outcome was the occurrence of an adverse event (renal replacement therapy, extracorporeal membrane oxygenation, 30-day mortality after ICU admission).Results: Among 181 patients, 62% (n=112/181) presented RVD. The RV/LV ratio was 1.10 [1. 05-1.18]  in the RVD group and 0.88 [0.84-0.96] in the non-RVD group (p=0.001). Adverse clinical events were 30% and identical in the two groups (p=0.73). In ROC analysis, the RV/LV ratio measurement failed to identify patients with adverse events. On multivariable Cox analysis, RVD was not associated with adverse events to the contrary to chest tomography severity score > 10 (hazards ratio=1.70, 95%CI [1.03-2.94];p=0.04) and cardiovascular component (> 2) of the SOFA score (HR=2.93, 95% CI[1.44-5.95], p=0.003).RV dilatation assessed by RV/LV ratio was a common CTPA finding in nonintubated critical patients with COVID-19 pneumonia and was not associated with the occurrence of clinical adverse events.