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

Intensive Care Med. 2022 Aug;48(8):1104-1105. doi: 10.1007/s00134-022-06742-w. PubMed

Intensive Care Med. 2022 Aug;48(8):1106-1107. doi: 10.1007/s00134-022-06774-2. PubMed

Intensive Care Med. 2023 Jan;49(1):99-102. doi: 10.1007/s00134-022-06904-w. PubMed

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Michard F, Vieillard-Baron A. Critically-ill patients with COVID-19: are they hemodynamically unstable and do we know why? Intensive Care Med. 2021;47(2):254–255. doi: 10.1007/s00134-020-06238-5. PubMed DOI PMC

Zhou F, Yu T, Fan G, Liu Z, Xiang J, Wang Y, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. doi: 10.1016/S0140-6736(20)30566-3. PubMed DOI PMC

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan. China JAMA Cardiol. 2020;5(7):802–810. doi: 10.1001/jamacardio.2020.0950. PubMed DOI PMC

Hendren N, Drazner M, Bozkurt B, Cooper L. Description and proposed management of the acute COVID-19 cardiovascular syndrome. Circulation. 2020;141:1903–1914. doi: 10.1161/CIRCULATIONAHA.120.047349. PubMed DOI PMC

Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. A prospective cohort study. Ann Intern Med. 2020;173(4):268–277. doi: 10.7326/M20-2003. PubMed DOI PMC

Gattinoni L, Chiumello D, Caironi P, Busana M, Rominiti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–1102. doi: 10.1007/s00134-020-06033-2. PubMed DOI PMC

Mekontso-Dessap A, Boissier F, Charron C, Bégot E, Repessé X, Legras A, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive Care Med. 2016;42:862–870. doi: 10.1007/s00134-015-4141-2. PubMed DOI

Topol EJ. COVID-19 can affect the heart. Science. 2020;370(6515):408–409. doi: 10.1126/science.abe2813. PubMed DOI

Dweck M, Bularga A, Hahn R, Bing R, Lee KK, Chapman AR, et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging. 2020;21(9):949–958. doi: 10.1093/ehjci/jeaa178. PubMed DOI PMC

Sanfilippo F, Huang S, Herpain A, Balik M, Chew M, Clau-Terré F, et al. The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies. Intensive Care Med. 2021;47(1):1–13. doi: 10.1007/s00134-020-06262-5. PubMed DOI

Doyen D, Dupland P, Morand L, Fourrier E, Saccheri C, Buscot M, et al. Characteristics of cardiac injury in critically ill patients with coronavirus disease 2019. Chest. 2021;159(5):1974–1985. doi: 10.1016/j.chest.2020.10.056. PubMed DOI PMC

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-COV-2 admitted to ICUs of the Lombardy region. Italy JAMA. 2020;323(16):1574–1581. doi: 10.1001/jama.2020.5394. PubMed DOI PMC

COVID-ICU group on behalf of the REVA network and the COVID-ICU investigators Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47(1):60–73. doi: 10.1007/s00134-020-06294-x. PubMed DOI PMC

Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med. 2003;168(11):1270–1276. doi: 10.1164/rccm.200306-816CC. PubMed DOI

Kox M, Waalders N, Kooistra E, Gerretsen J, Pickkers P. Cytokine levels in critically ill patients with COVID-19 and other conditions. JAMA. 2020;324(15):1565–1567. doi: 10.1001/jama.2020.17052. PubMed DOI PMC

Del Valle D, Kim-Schulze S, Huang H, Beckmann N, Nirenberg S, Wang B, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med. 2020;26(10):1636–1643. doi: 10.1038/s41591-020-1051-9. PubMed DOI PMC

Nagueh SF, Smiseth OA, Appleton CP, Byrd B, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321–1360. doi: 10.1093/ehjci/jew082. PubMed DOI

Hollenberg S, Safi L, Parrillo J, Fata M, Klinkhammer B, Gayed N, et al. Hemodynamic profiles of shock in patients with COVID-19. Am J Cardiol. 2021;153:135–139. doi: 10.1016/j.amjcard.2021.05.029. PubMed DOI PMC

Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med. 2002;166(10):1310–1319. doi: 10.1164/rccm.200202-146CC. PubMed DOI

Evrard B, Goudelin M, Montmagnon N, Fedou A, Lafon T, Vignon P. Cardiovascular phenotypes in ventilated patients with COVID-19 acute respiratory distress syndrome. Crit Care. 2020;24(1):236. doi: 10.1186/s13054-020-02958-8. PubMed DOI PMC

Kim J, Volodarskiy A, Sultan R, Pollie MP, Yum B, Nambiar L, et al. Prognostic utility of right ventricular remodeling over conventional risk stratification in patients with COVID-19. J Am Coll Cardiol. 2020;76(17):1965–1977. doi: 10.1016/j.jacc.2020.08.066. PubMed DOI PMC

Bleakley C, Singh S, Garfield B, Morosin M, Surkova E, Mandalia S, Dias B, Androulakis E, Proce LC, McCabe C, Wort SJ, West C, Li W, Khattar R, Senior R, Patel BV, Price S. Right ventricular dysfunction in critically illCOVID-19 ARDS. Int J Cardiol. 2021;327:251–258. doi: 10.1016/j.ijcard.2020.11.043. PubMed DOI PMC

Cavaleiro P, Masi P, Bagate F, d’Humières T, Mekontso-Dessap A. Acute cor pulmonale in COVID-19 related acute respiratory distress syndrome. Crit Care. 2021;25(1):346. doi: 10.1186/s13054-021-03756-6. PubMed DOI PMC

Ackermann M, Verleden S, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary vascular endothelialitis thrombosis and angiogenesis in COVID-19. N Engl J Med. 2020;383(2):120–128. doi: 10.1056/NEJMoa2015432. PubMed DOI PMC

Archer S, Sharp W, Weir E. Differentiating COVID-19 pneumonia from acute respiratory distress syndrome and high altitude pulmonary edema: therapeutic implications. Circulation. 2020;142(2):101–104. doi: 10.1161/CIRCULATIONAHA.120.047915. PubMed DOI PMC

Caravita S, Baratto C, Di Marco F, Calabrese A, Balestrieri G, Russo F, et al. Haemodynamic characteristics of COVID-19 patients with acute respiratory distress syndrome requiring mechanical ventilation. An invasive assessment using right heart catheterization. Eur J Heart Fail. 2020;22(12):228–2237. doi: 10.1002/ejhf.2058. PubMed DOI PMC

Soulat-Dufour L, Fauvel C, Weizman O, Barbe T, Pezel T, Mika D, et al. Prognostic value of right ventricular dilatation in patients with COVID-19: a multicenter study. Eur Heart J Cardiovasc Imaging. 2021 doi: 10.1093/ehjci/jeab067. PubMed DOI PMC

Silverio A, Di Maio M, Scudiero F, Russo V, Esposito L, Attena E, et al. Clinical conditions and echocardiographic parameters associated with mortality in COVID-19. Eur J Clin Invest. 2021;51:e13638. doi: 10.1111/eci.13638. PubMed DOI PMC

Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study