The Egyptian Heart Journal (May 2022)

Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes

  • Ran Tao,
  • Zuzana Burivalova,
  • S. Carolina Masri,
  • Naga Dharmavaram,
  • Aurangzeb Baber,
  • Roderick Deaño,
  • Timothy Hess,
  • Ravi Dhingra,
  • James Runo,
  • Nizar Jarjour,
  • Rebecca R. Vanderpool,
  • Naomi Chesler,
  • Joanna E. Kusmirek,
  • Marlowe Eldridge,
  • Christopher Francois,
  • Farhan Raza

DOI
https://doi.org/10.1186/s43044-022-00274-w
Journal volume & issue
Vol. 74, no. 1
pp. 1 – 10

Abstract

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Abstract Background Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease. Results We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1. Conclusions In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.

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