Usefulness of right ventricular longitudinal shortening fraction to detect right ventricular dysfunction in acute cor pulmonale related to COVID-19.: Acute cor pulmonale in COVID-19

Beyls, Christophe; Bohbot, Yohann; Huette, Pierre; Booz, Thomas; Daumin, Camille; Abou-Arab, Osama; Mahjoub, Yazine

OBJECTIVE: To compare 2D-speckle tracking echocardiographic parameters (2D-STE) and classical echocardiographic parameters of right ventricular (RV) systolic function in patients with COVID-19 related acute respiratory distress syndrome (CARDS) complicated or not by acute cor pulmonale (ACP). DESIGN: Prospective, between March 1(st) and April 15(th), 2020. SETTING: Intensive care unit of Amiens university hospital (France). PARTICIPANTS: Adult patients with moderate-to-severe CARDS under mechanical ventilation for less than 24 hours. INTERVENTION: None. MEASUREMENT AND MAINS RESULTS: Tricuspid annular displacement (TAD) parameters (TAD-septal, TAD-lateral and RV longitudinal shortening fraction [RV-LSF]), RV global longitudinal strain (RV-GLS) and RV free wall longitudinal strain (RVFWLS) were measured using transesophageal echocardiography with a dedicated software and compared to classical RV systolic parameters (RV-FAC, S’ wave and TAPSE). RV systolic dysfunction was defined as RV-FAC <35%. Twenty-nine consecutive patients with moderate to severe CARDS were included. ACP was diagnosed in 12 patients (41%). 2D-STE parameters were markedly altered in the ACP group, while no significant difference was found between patients with and without ACP for classical RV parameters (RV-FAC, S’ wave and TAPSE). In the ACP group, RV-LSF (17[14-22]%) had the best correlation with RV-FAC (r=0.79,p<0.001 vs r=0.27, p=0.39 for RVGLS and r=0.28,p=0.39 for RVFWLS). A RV-LSF cut-off value of 17% had a sensitivity of 80% and a specificity of 86% to identify RV systolic dysfunction. CONCLUSION: Classical RV function parameters were not altered by ACP in patients with CARDS to the contrary to 2D-STE parameters. RV-LSF seems to be a valuable parameter to detect early RV systolic dysfunction in CARDS patients with ACP.