Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study

Huang, S; Vieillard-Baron, A; Evrard, B; Prat, G; Chew, MS; Balik, M; Clau-Terré, F; De Backer, D; Mekontso Dessap, A; Orde, S; Morelli, A; Sanfilippo, F; Charron, C; Vignon, P; ECHO-COVID study group

doi:10.1007/s00134-023-07147-z

Respiratory failure & ventilation

Echocardiography phenotypes of right ventricular involvement in COVID-19 acute respiratory distress syndrome (ARDS) patients and intensive care unit (ICU) mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study

Intensive Care MedPublished 12 Jul 2023Secondary analysis of the ECHO-COVID observational study

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Authors' conclusion

Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.

Study context

Population: ICU patients with COVID-19 ARDS who underwent at least two echocardiography examinations

Comparison: Right ventricular (RV) involvement phenotypes vs none
Acute cor pulmonale (ACP)n = 105
RV failure (RVF)n = 140
RV dysfunctionn = 74
Primary endpoint: ICU mortality (survival time)

Methodological detailspost-hoc, exploratory, multicentre, longitudinal, accelerated failure time model, multistate model

Post-hoc
Exploratory
Multicentre
Longitudinal
Accelerated failure time model
Multistate model

Primary result

As reported in the abstract

ICU survival time

Survival time shortened by factor

0.479

CI 0.284–0.803P = 0.005

ACP · all examinations displaying ACP vs all depicting no ACP

Survival time shortened by factor

0.642

CI 0.405–1.018P = 0.059

RVF · trend

Further findings

Outcome	← Lower risk with ACP ←→ Higher risk with ACP →	HR (CI)	P value
Mortality by ACP at last CCE examination (multistate analysis)ACP vs No ACP · ACP in last CCE examination; highest risk	0.20.5125	3.25 (2.38–4.45)	P < 0.001
	0.20.5125Hazard ratio (log scale)

Outcome	ACP	RVF	RV dysfunction
Prevalence of RV involvement	37.4%	54.7%	29%

Prevalence of RV involvement — At least 1 type of RV involvement: 189 (67%)

Prevalence of RV involvement: denominators 281, 256 and 255

Mortality by ACP at last critical care echocardiography (CCE) examination (multistate analysis)

Patients might transit in and out of RV involvement

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study. Intensive Care Med. Published 12 July 2023. doi:10.1007/s00134-023-07147-z

Read the original article ↗

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