• Jiwon Kim, Alexander Volodarskiy, Razia Sultana, Meridith P Pollie, Brian Yum, Lakshmi Nambiar, Romina Tafreshi, Hannah W Mitlak, Arindam RoyChoudhury, Evelyn M Horn, Ingrid Hriljac, Nupoor Narula, Sijun Kim, Lishomwa Ndhlovu, Parag Goyal, Monika M Safford, Leslee Shaw, Richard B Devereux, and Jonathan W Weinsaft.
• Division of Cardiology, Weill Cornell Medicine, New York, New York; Department of Radiology, Weill Cornell Medicine, New York, New York. Electronic address: jik9027@med.cornell.edu.
• J. Am. Coll. Cardiol. 2020 Oct 27; 76 (17): 1965-1977.

BackgroundCoronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain.ObjectivesThe purpose of this study was to test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification.MethodsConsecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at 3 New York City hospitals were studied; images were analyzed by a central core laboratory blinded to clinical and biomarker data.ResultsIn total, 510 patients (age 64 ± 14 years, 66% men) were studied; RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p = 0.007). During inpatient follow-up (median 20 days), 77% of patients had a study-related endpoint (death 32%, discharge 45%). RV dysfunction (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.49 to 4.43; p = 0.001) and dilation (HR: 1.43; 95% CI: 1.05 to 1.96; p = 0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR: 1.39; 95% CI: 1.01 to 1.90; p = 0.041). RV indices provided additional risk stratification beyond biomarker strata; risk for death was greatest among patients with adverse RV remodeling and positive biomarkers and was lesser among patients with isolated biomarker elevations (p ≤ 0.001). In multivariate analysis, adverse RV remodeling conferred a >2-fold increase in mortality risk, which remained significant (p < 0.01) when controlling for age and biomarker elevations; the predictive value of adverse RV remodeling was similar irrespective of whether analyses were performed using troponin, D-dimer, or ferritin.ConclusionsAdverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.Published by Elsevier Inc.

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