Imperial College London
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DrBrijeshPatel

Faculty of Medicine, Department of Surgery & Cancer

Clinical Senior Lecturer in Cardiothoracic
 
 
 
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Contact

 

+44 (0)20 3315 8897brijesh.patel Website

 
 
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Location

 

Adult Intensive Care UnitSydney StreetRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bleakley:2021:10.1016/j.ijcard.2020.11.043,
author = {Bleakley, C and Singh, S and Garfield, B and Morosin, M and Surkova, E and Mandalia, MS and Dias, B and Androulakis, E and Price, LC and McCabe, C and Wort, SJ and West, C and Li, W and Khattar, R and Senior, R and Patel, BV and Price, S},
doi = {10.1016/j.ijcard.2020.11.043},
journal = {International Journal of Cardiology},
pages = {251--258},
title = {Right ventricular dysfunction in critically ill COVID-19 ARDS},
url = {http://dx.doi.org/10.1016/j.ijcard.2020.11.043},
volume = {327},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - AIMS: Comprehensive echocardiography assessment of right ventricular (RV) impairment has not been reported in critically ill patients with COVID-19. We detail the specific phenotype and clinical associations of RV impairment in COVID-19 acute respiratory distress syndrome (ARDS). METHODS: Transthoracic echocardiography (TTE) measures of RV function were collected in critically unwell patients for associations with clinical, ventilatory and laboratory data. RESULTS: Ninety patients (25.6% female), mean age 52.0 ± 10.8 years, veno-venous extracorporeal membrane oxygenation (VVECMO) (42.2%) were studied. A significantly higher proportion of patients were identified as having RV dysfunction by RV fractional area change (FAC) (72.0%,95% confidence interval (CI) 61.0-81.0) and RV velocity time integral (VTI) (86.4%, 95 CI 77.3-93.2) than by tricuspid annular plane systolic excursion (TAPSE) (23.8%, 95 CI 16.0-33.9), RVS' (11.9%, 95% CI 6.6-20.5) or RV free wall strain (FWS) (35.3%, 95% CI 23.6-49.0). RV VTI correlated strongly with RV FAC (p ≤ 0.01). Multivariate regression demonstrated independent associations of RV FAC with NTpro-BNP and PVR. RV-PA coupling correlated with PVR (univariate p < 0.01), as well as RVEDAi (p < 0.01), and RVESAi (p < 0.01), and was associated with P/F ratio (p 0.026), PEEP (p 0.025), and ALT (p 0.028). CONCLUSIONS: Severe COVID-19 ARDS is associated with a specific phenotype of RV radial impairment with sparing of longitudinal function. Clinicians should avoid interpretation of RV health purely on long-axis parameters in these patients. RV-PA coupling potentially provides important additional information above standard measures of RV performance in this cohort.
AU  - Bleakley,C
AU  - Singh,S
AU  - Garfield,B
AU  - Morosin,M
AU  - Surkova,E
AU  - Mandalia,MS
AU  - Dias,B
AU  - Androulakis,E
AU  - Price,LC
AU  - McCabe,C
AU  - Wort,SJ
AU  - West,C
AU  - Li,W
AU  - Khattar,R
AU  - Senior,R
AU  - Patel,BV
AU  - Price,S
DO  - 10.1016/j.ijcard.2020.11.043
EP  - 258
PY  - 2021///
SN  - 0167-5273
SP  - 251
TI  - Right ventricular dysfunction in critically ill COVID-19 ARDS
T2  - International Journal of Cardiology
UR  - http://dx.doi.org/10.1016/j.ijcard.2020.11.043
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33242508
UR  - http://hdl.handle.net/10044/1/87698
VL  - 327
ER  -
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