PURPOSE: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). METHODS: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). RESULTS: Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). CONCLUSION: Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.

CHIREC Hospitals Université Libre de Bruxelles Brussels Belgium

Department Clinical Internal Anesthesiological and Cardiovascular Sciences University of Rome La Sapienza Policlinico Umberto Primo Viale del Policlinico Rome Italy

Department of Anaesthesiology and Critical Care Medicine Vall d'Hebron University Hospital Barcelona Spain

Department of Anaesthesiology and Intensive Care Biomedical and Clinical Sciences Linköping University Linköping Sweden

Department of Anesthesia and Intensive Care Policlinico Vittorio Emanuele University Hospital Catania Italy

Department of Anesthesiology and Critical Care Medicine Hôpital Européen Georges Pompidou AP HP and Université de Paris 20 Rue Leblanc 75015 Paris France

Department of Anesthesiology and Intensive Care General University Hospital and 1st Medical Faculty Charles University Prague Czechia

Division of Pulmonary Critical Care and Allergy Department of Medicine UmassMemorial Medical Center The University Hospital for University of Massachusetts Worcester MA USA

Division of Pulmonary Critical Care and Sleep Medicine Northwell Health LIJ NSUH Medical Center Zucker School of Medicine Hofstra Northwell Hempstead NY USA

INSERM UMR 1018 Clinical Epidemiology Team CESP Université de Paris Saclay Villejuif France

Intensive Care Medicine Nepean Hospital The University of Sydney Sydney Australia

Medical Intensive Care Unit Amiens University Hospital Amiens France

Medical Surgical ICU Dupuytren Teaching Hospital Inserm CIC 1435 and UMR 1092 87000 Limoges France

Service de Médecine Intensive Réanimation Assistance Publique Hôpitaux de Paris University Hospital Ambroise Paré 92100 Boulogne Billancourt France

Service de Médecine Intensive Réanimation CHU Cavale Blanche Brest Brest France

Service de Médecine Intensive Réanimation Hôpitaux universitaires Henri Mondor Assistance Publique Hôpitaux de Paris Groupe de Recherche Clinique CARMAS Inserm U955 Université Paris Est Créteil 94000 Créteil France

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