Right Ventricular Dysfunction in Patients With COVID-19: a systematic review and meta-analysis

Paternoster, Gianluca; Bertini, Pietro; Innelli, Pasquale; Trambaiolo, Paolo; Landoni, Giovanni; Franchi, Federico; Scolletta, Sabino; Guarracino, Fabio

OBJECTIVE: This systematic review and meta-analysis aimed to describe the features of right ventricular impairment and pulmonary hypertension in COVID-19 and assess its effect on mortality. DESIGN: We carried out a systematic review and meta-analysis of observational studies. SETTING: We performed a search through Pubmed, the International Clinical Trials Registry Platform, and the Cochrane Library for studies reporting right ventricular dysfunction in COVID-19 patients and outcomes. PARTICIPANTS: The search yielded 9 studies in which the appropriate data were available. INTERVENTIONS: Pooled odds ratio were calculated according to the random effects model. MEASUREMENTS AND MAIN RESULTS: Overall, 1450 patients were analyzed, half of them invasively ventilated. Primary outcome was mortality at the longest follow-up available. Mortality was 48.5% versus 24.7% in patients with or without right ventricular impairment, (n = 7, OR = 3.10; 95% CI 1.72 – 5.58; p = 0.0002), 56.3% versus 30.6%, in patients with or without right ventricular dilatation (n = 6; OR = 2.43; 95% CI 1.41 – 4.18; p = 0.001), and 52.9% versus 14.8% in patients with or without pulmonary hypertension, (n = 3; OR = 5.75; 95% confidence intervals 2.67 – 12.38; p < 0.001). CONCLUSION: Mortality of COVID-19 patients requiring respiratory support and with a diagnosis of right ventricular dysfunction, dilatation or pulmonary hypertension, is high. Future studies should highlight the mechanisms of right ventricular derangement in COVID-19 while early detection of right ventricular impairment using ultrasound might be important to individualize therapies and improve outcomes.