Key result
Global right ventricular ejection fraction was significantly lower in patients with ARDS unrelated to SARS-CoV-2 (median 43%) compared to those with SARS-CoV-2 ARDS (58%) and controls without ARDS (65%).
Why the study?
To compare global and axial right ventricular ejection fraction in ventilated patients with moderate-to-severe ARDS from early SARS-CoV-2 pneumonia versus other causes, and ventilated controls without ARDS.
Does right ventricular mechanics assessed by 3D transesophageal echocardiography differ between early-stage SARS-CoV-2 ARDS, non-SARS-CoV-2 ARDS, and ventilated controls?
Cross-Sectional (n=64)
No
Does right ventricular mechanics assessed by 3D transesophageal echocardiography differ between early-stage SARS-CoV-2 ARDS, non-SARS-CoV-2 ARDS, and ventilated controls?
Absolute Event Rate: 43% vs 58%
p-value: p=<0.001
Right ventricular systolic function, particularly radial shortening, is more severely impaired in early-stage non-SARS-CoV-2 ARDS compared to SARS-CoV-2 ARDS.
RV systolic function appears more preserved in early COVID ARDS than non-COVID ARDS; leaves open etiology-specific RV mechanics for prospective validation.
Aim To compare global and axial right ventricular ejection fraction in ventilated patients for moderate-to-severe acute respiratory distress syndrome (ARDS) secondary to early SARS-CoV-2 pneumonia or to other causes, and in ventilated patients without ARDS used as reference. Methods Retrospective single-center cross-sectional study including 64 ventilated patients: 21 with ARDS related to SARS-CoV-2 (group 1), 22 with ARDS unrelated to SARS-CoV-2 (group 2), and 21 without ARDS (control group). Real-time three-dimensional transesophageal echocardiography was performed for hemodynamic assessment within 24 h after admission. Contraction pattern of the right ventricle was decomposed along the three anatomically relevant axes. Relative contribution of each spatial axis was evaluated by calculating ejection fraction along each axis divided by the global right ventricular ejection fraction. Results Global right ventricular ejection fraction was significantly lower in group 2 than in both group 1 and controls [median: 43% (25–75th percentiles: 40–57) vs. 58% (55–62) and 65% (56–68), respectively: p < 0.001]. Longitudinal shortening had a similar relative contribution to global right ventricular ejection fraction in all groups [group 1: 32% (28–39), group 2: 29% (24–40), control group: 31% (28–38), p = 0.6]. Radial shortening was lower in group 2 when compared to both group 1 and controls [45% (40–53) vs. 57% (51–62) and 56% (50–60), respectively: p = 0.005]. The relative contribution of right ventricular shortening along the anteroposterior axis was not statistically different between groups [group 1: 51% (41–55), group 2: 56% (46–63), control group; 56% (50–64), p = 0.076]. Conclusion During early hemodynamic assessment, the right ventricular systolic function appears more impaired in ARDS unrelated to SARS-CoV-2 when compared to early stage SARS-CoV-2 ARDS. Radial shortening appears more involved than longitudinal and anteroposterior shortening in patients with ARDS unrelated to SARS-CoV-2 and decreased right ventricular ejection fraction.
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Evrard et al. (2022) conducted a cross-sectional in Acute Respiratory Distress Syndrome (ARDS) (n=64). ARDS unrelated to SARS-CoV-2 vs. SARS-CoV-2 ARDS and controls without ARDS was evaluated on Global right ventricular ejection fraction (p=<0.001). Global right ventricular ejection fraction was significantly lower in patients with ARDS unrelated to SARS-CoV-2 (median 43%) compared to those with SARS-CoV-2 ARDS (58%) and controls without ARDS (65%).
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