Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized with COVID-19 according to Race

Moody, William E.; Mahmoud-Elsayed, Hani M.; Senior, Jonathan; Gul, Uzma; Khan-Kheil, Ayisha M.; Horne, Sebastian; Banerjee, Amitava; Bradlow, William M.; Huggett, Robert; Hothi, Sandeep S.; Shahid, Muhammad; Steeds, Richard P.

BACKGROUND: Epidemiological studies suggest that black, Asian and minority ethnic (BAME) patients may be at risk of worse outcomes from Coronavirus-19 (COVID-19) but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality and race in COVID-19 pneumonia. METHODS: This was a multicenter, retrospective, observational study including 164 adults (61±13years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (IQR 2 – 5) from admission. The primary outcome was all-cause mortality. RESULTS: After a median follow up of 31 days (IQR 14 – 42 days), 58 (35%) patients had died. The right ventricle (RV) was dilated in 62 (38%) patients, and 58 (35%) patients had RV systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = −0.18, p = 0.025) and high-sensitivity cardiac Troponin (ρ = −0.30, p < 0.0001). Reduced RV systolic function (HR, 1.80; 95% CI, 1.05 – 3.09; p = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers or mortality. CONCLUSIONS: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is however, no racial variation in the early findings on echocardiography, biomarkers or mortality.