Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support

doi:10.4330/wjc.v15.i4.165

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World Journal of Cardiology

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World J Cardiol. Apr 26, 2023; 15(4): 165-173
Published online Apr 26, 2023. doi: 10.4330/wjc.v15.i4.165

Table 1 Comparison between patients with right ventricle dilatation and dysfunction and those without, n %

Variable	All patients	RVDD (No. 34)	No RVDD (No. 27)	P value
Clinical data
Age (yr), mean ± SD	54.3 ± 10.3	53.8 ± 9.7	52.9 ± 11	0.735
Gender, M/F	45/16 (74/26)	28/6 (82/18)	17/10 (63/37)	0.087
BMI (kg/m²), mean ± SD	32.9 ± 5.3	32.4 ± 5.6	32.7 ± 4.9	0.836
Charlson index, median (IQR)	2.0 (1.0-3.0)	2.0 (1.0-3.0)	2.0 (1.0-3.0)	0.772
Transferred from peripheral hospitals	38 (62)	18 (52)	20 (74)	0.9
Time from symptoms’ onset to ICU (d), median (IQR)	13 (10-13)	9 (8-12)	12 (10-14)	0.075
SOFA, median (IQR)	8.0 (7.0-10.0)	10 (8-10)	7 (6-10)	0.029
Mechanical ventilation length to ECMO support (d), median (IQR)	6.0 (8.0-11.0)	8.5 (6-12)	7 (4-10)	0.046
ECMO duration (d), median (IQR)	22 (13-42)	24.5 (9-44)	21 (15-35)	0.765
Renal replacement therapy	29 (48)	22 (65)	7 (26)	0.002
ICU death	33 (54.1)	21 (62)	12 (44)	0.024
Biohumoral data
Creatinine (mg/dL), median (IQR)	1.00 (0.72-1.86)	0.83 (0.61-1.34)	1.65 (0.78-2.00)	0.025
D-dimer (ng/mL), median (IQR)	3594 (2252-7214)	3748 (1740-12085)	3550 (2368-5007)	0.425
CRP (mg/dL), median (IQR)	142 (88-144)	121 (87-174)	165 (98-212)	0.55
IL-6 (pg/mL), median (IQR)	34 (7.4-70.0)	45 (6.9-105.0)	34 (21-58.0)	0.772
Troponin (pg/mL), median (IQR)	21 (14.0-38.0)	33.0 (14.0-112.0)	21.0 (8.5-48.0)	0.253
NT-pro BNP (pg/mL), median (IQR)	874 (345-1654)	735 (252-1467)	1273 (585-1868)	0.058
LDH IU/L, median (IQR)	465 (375-538)	421 (363-510)	473 (424-542)	0.078
Echocardiographic data
LVEF (%), mean ± SD	63.9 ± 7.6	64.3 ± 7.9	64.5 ± 7.5	0.113
RV/LV, mean ± SD	0.58 ± 0.17	0.69 ± 0.08	0.45 ± 0.14	0.0001
TAPSE (mm), mean ± SD	18.0 (10.0-21.0)	13.9 (10.0 ± 14.5)	17.4 (16.0-22.5)	0.015
sPAP (mmHg), mean ± SD	58.4 ± 9.4	64 ± 11	59.1 ± 7.7	0.015
e/e1	11 ± 3	12 ± 3	9 ± 3	0.0003
TAPSE/sPAP (mm/mmHg), mean ± SD	0.28 ± 0.13	0.19 ± 0.10	0.28 ± 0.11	0.001
Ventilatory parameters
PEEP (cm H₂O), mean ± SD	12.2 ± 2.3	12.4 ± -2.4	12.1 ± 2.6	0.64
PO₂/FiO₂, mean ± SD	62 (50-88)	66 (54-88)	60 (50-88)	0.442
Norepinephrine, mean ± SD	0.34 ± 0.22	0.39 ± 0.26	0.24 ± 0.10	0.011

IQR: Interquartile range; RVDD: Right ventricle dilatation and dysfunction; BMI: Body mass index; ICU: Intensive care unit; LOS: Length of stay; CRP: C-reactive protein; IL-6: Interleukin 6, SOFA: Simplified organ functional assessment; ECMO: Extracorporeal membrane oxygenation; NT pro BNP: N terminal pro brain natriuretic peptide; RV: Right ventricle; LV: Left ventricle; EF: Ejection fraction; TAPSE: Tricuspid annular plane systolic excursion; sPAP: Systolic pulmonary arterial pressure; LDH: Lactate dehydrogenase; LVEF: Left ventricular ejection fraction; PEEP: Positive end-expiratory pressure.

Table 2 Comparison between survivors and no survivors, n %

Variable	All patients	Survivors (No. 28)	No survivors (No. 33)	P value
Clinical data
Age (yr), mean ± SD	54.3 ± 10.3	50.1 ± 11.6	58.0 ± 7.3	0.003
Gender, M/F	45/16 (73.8/26.2)	18/10 (40.0/62.5)	6/27 (60.0/37.5)	0.121
BMI (kg/m²), mean ± SD	32.9 ± 5.3	31.8 ± 4.0	33.8 ± 6.1	0.138
Charlson index, median (IQR)	2.0 (1.0-3.0)	2.0 (1.0-3.0)	2.0 (1.0-3.0)	0.772
Time from symptoms’ onset to ICU (d), median (IQR)	13 (10-13)	10 (8-13)	13 (10-15)	0.066
SOFA, median (IQR)	8.0 (7.0-10.0)	7.5 (5.5-9.0)	10.0 (8.0-10.0)	0.01
Mechanical ventilation length to ECMO support (d), median (IQR)	6.0 (8.0-11.0)	6.5 (4.5-9.5)	10.0 (7.0-12.0)	0.006
ECMO duration (d), median (IQR)	22 (13-42)	35 (19-48)	18 (10-30)	0.015
ICU death	33 (54.1)	-	-	-
Biohumoral data
Creatinine (mg/dL), median (IQR)	1.00 (0.70-1.88)	0.82 (0.60-1.35)	1.60 (0.77-2.00)	0.03
D-dimer (ng/mL), median (IQR)	3694 (2153-7326)	3948 (1740-13095)	3600 (2378-5007)	0.418
CRP (mg/dL), median (IQR)	140 (86-143)	120 (85-172)	164 (97-215)	0.553
IL-6 (pg/mL), median (IQR)	35.5 (7.9-71.0)	46.5 (6.8-107.0)	35.5 (20.5-59.0)	0.851
Troponin (pg/mL), median (IQR)	20.5 (15.0-39.0)	34.0 (15.0-115.0)	22.0 (9.0-50.0)	0.281
NT-pro BNP (pg/mL), median (IQR)	875 (355-1754)	734 (254-1542)	1272 (586-1870)	0.064
LDH IU/L, median (IQR)	466 (378-540)	423 (367-513)	475 (426-543)	0.089
Echocardiographic data
LVEF (%)	63.9 ± 7.6	65.6 ± 8.1	62.5 ± 6.9	0.113
RV/LV	0.58 ± 0.17	0.58 ± 0.19	0.58 ± 0.16	0.945
TAPSE (mm)	18.0 (10.0-21.0)	19.0 (10.0 ± 22.5)	18.0 (10.0-21.0)	0.375
RVDD	34 (55.7)	13	21	0.275
sPAP (mmHg)	58.4 ± 9.4	60.2 ± 7.6	61.3 ± 10.7	0.638
E/e1	11 ± 3	10.7 ± 2.9	11.6 ± 3.7	0.34
TAPSE/sPAP (mm/mmHg)	0.28 ± 0.13	0.29 ± 0.13	0.27 ± 0.13	0.692
Ventilatory parameters
PEEP (cm H₂O)	12.2 ± 2.3	12.3 ± 2.3	12.2 ± 2.4	0.91
PO₂/FiO₂	62 (50-88)	66 (54-88)	60 (50-88)	0.442
Norepinephrine (μg/kg/min), mean ± SD	0.34 ± 0.22	0.30 ± 0.20	0.35 ± 0.24	0.388

IQR: Interquartile range; RVDD: Right ventricle dilatation and dysfunction; BMI: Body mass index; ICU: Intensive care unit; LOS: Length of stay; CRP: C-reactive protein; IL-6: Interleukin 6; SOFA: Simplified organ functional assessment; ECMO: Extracorporeal membrane oxygenation; NT pro BNP: N terminal pro brain natriuretic peptide; RV: Right ventricle; LV: Left ventricle; EF: Ejection fraction; TAPSE: Tricuspid annular plane systolic excursion; sPAP: Systolic pulmonary arterial pressure; LDH: Lactate dehydrogenase; LVEF: Left ventricular ejection fraction; PEEP: Positive end-expiratory pressure.

Table 3 Multivariate logistic regression analysis (intensive care unit death outcome)

Model	OR	95%CI	P value
Model 1
Age (yr)	1.09	1.02-1.16	0.015
SOFA	1.26	0.99-1.62	0.062
Admission RV/LV	0.64	0.02-21.42	0.805
Model 2
SOFA	1.24	0.98-1.56	0.062
RV DYS	0.98	0.31-3.84	0.985
Creatinine (mg/dL)	1.78	0.82-3.11	0.14
Model 3
Age (yr)	1.1	1.03-1.18	0.005
BMI (kg/m²)	1.09	0.97-1.22	0.138
TAPSE (mm)	0.97	0.89-1.06	0.544
Model 4
SOFA	1.29	1.03-1.61	0.026
BMI (kg/m²)	1.06	0.95-1.19	0.278
TAPSE/SPAP (mm/mmHg)	2.53	0.03-20.92	0.68
Model 5
BMI (kg/m²)	1.1	0.98-1.24	0.107
Charlson index	0.59	0.29-1.18	0.133
Time from symptom’s onset (d)	1.26	1.02-1.56	0.032
Model 6
NT pro BNP (pg/mL)	0.99	0.97-1.02	0.517
Mechanical ventilation to ECMO ≥ 10 (d)	4.64	1.42-15.12	0.011
Creatinine (mg/dL)	2.56	1.16-5.67	0.02

BMI: Body mass index; SOFA: Symplified organ functional assessment; RV: Right ventricle; TAPSE: Tricuspid annular plane systolic excursion; sPAP: Systolic pulmonary arterial pressure; ECMO: Extracorporeal membrane oxygenation; NT-pro BNP: N terminal pro brain natriuretic peptide; OR: Odd ratio; CI: Confidence index.

Citation: Lazzeri C, Bonizzoli M, Batacchi S, Cianchi G, Franci A, Socci F, Chiostri M, Peris A. Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support. World J Cardiol 2023; 15(4): 165-173
URL: https://www.wjgnet.com/1949-8462/full/v15/i4/165.htm
DOI: https://dx.doi.org/10.4330/wjc.v15.i4.165