Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS.
Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS.
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DOI：
10.1186/s13054-020-03385-5
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发表时间：
2020-11-30
期刊：
影响因子：
--
通讯作者：
Golino P
中科院分区：
文献类型：
--
作者：
D'Alto M;Marra AM;Severino S;Salzano A;Romeo E;De Rosa R;Stagnaro FM;Pagnano G;Verde R;Murino P;Farro A;Ciccarelli G;Vargas M;Fiorentino G;Servillo G;Gentile I;Corcione A;Cittadini A;Naeije R;Golino P
探讨冠状病毒感染性疾病2019 （COVID-19）合并急性呼吸窘迫综合征（ARDS）患者右心衰和右心室动脉解耦的患病率及对预后的影响。连续纳入94例因COVID-19急性呼吸衰竭入院的患者（平均年龄64岁）。通过全面的经胸超声心动图评估右心室功能与肺循环的耦合，重点是三尖瓣环平面收缩偏移（TAPSE）与收缩期肺动脉压（PASP）的比值。大多数患者需要通气支持，其中22例为无创，37例为有创。有25例死亡，均为有创通气患者。幸存者较年轻（62±13岁vs 68±12岁，p = 0.033），较少超重或经常吸烟，NT-proBNP和白细胞介素-6较低，动脉氧分压(PaO2)/吸入氧分数（FIO2）比较高（270±104比117±57 mmHg， p < 0.001）。在非幸存者中，PASP升高（42±12比30±7 mmHg， p < 0.001），而TAPSE降低（19±4比25±4 mm， p < 0.001）。因此，TAPSE/PASP比值低于幸存者（0.51±0.22 vs 0.89±0.29 mm/mmHg, p < 0.001）。在单因素/多变量分析中，TAPSE/PASP （HR: 0.026; 95%CI: 0.01-0.579; p: 0.019）和PaO2/FIO2 （HR: 0.988; 95%CI: 0.988 - 0.998; p: 0.018）比值是死亡率的唯一独立预测因子，roc确定的截止值分别为159 mmHg和0.635 mm/mmHg。COVID-19 ARDS与临床相关的右心室功能与肺循环分离相关；床边超声心动图TAPSE/PASP增加了COVID-19 ARDS患者PaO2/FIO2的预后相关性。
To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute Respiratory Distress Syndrome (ARDS). Ninety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio The majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270 ± 104 vs. 117 ± 57 mmHg, p < 0.001). In the non-survivors, PASP was increased (42 ± 12 vs. 30 ± 7 mmHg, p < 0.001), while TAPSE was decreased (19 ± 4 vs. 25 ± 4 mm, p < 0.001). Accordingly, the TAPSE/PASP ratio was lower than in the survivors (0.51 ± 0.22 vs. 0.89 ± 0.29 mm/mmHg, p < 0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR: 0.026; 95%CI 0.01–0.579; p: 0.019) and PaO2/FIO2 (HR: 0.988; 95%CI 0.988–0.998; p: 0.018) ratios were the only independent predictors of mortality, with ROC-determined cutoff values of 159 mmHg and 0.635 mm/mmHg, respectively. COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19.
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影响因子：
10.8
作者：
Lambermont, B;Ghuysen, A;D'Orio, V
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DOI：
10.1164/rccm.200202-146cc
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