PURPOSE: Exploratory study to evaluate the association of different phenotypes of right ventricular (RV) involvement and mortality in the intensive care unit (ICU) in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). METHODS: Post-hoc analysis of longitudinal data from the multicenter ECHO-COVID observational study in ICU patients who underwent at least two echocardiography examinations. Echocardiography phenotypes were acute cor pulmonale (ACP, RV cavity dilatation with paradoxical septal motion), RV failure (RVF, RV cavity dilatation and systemic venous congestion), and RV dysfunction (tricuspid annular plane systolic excursion ≤ 16 mm). Accelerated failure time model and multistate model were used for analysis. RESULTS: Of 281 patients who underwent 948 echocardiography studies during ICU stay, 189 (67%) were found to have at least 1 type of RV involvements during one or several examinations: ACP (105/281, 37.4%), RVF (140/256, 54.7%) and/or RV dysfunction (74/255, 29%). Patients with all examinations displaying ACP had survival time shortened by 0.479 [0.284-0.803] times when compared to patients with all examinations depicting no ACP (P = 0.005). RVF showed a trend towards shortened survival time by a factor of 0.642 [0.405-1.018] (P = 0.059), whereas the impact of RV dysfunction on survival time was inconclusive (P = 0.451). Multistate analysis showed that patients might transit in and out of RV involvement, and those who exhibited ACP in their last critical care echocardiography (CCE) examination had the highest risk of mortality (hazard ratio (HR) 3.25 [2.38-4.45], P < 0.001). CONCLUSION: RV involvement is prevalent in patients ventilated for COVID-19 ARDS. Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.

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 Intensive Care General University Hospital and 1St Medical Faculty Charles University Prague Czechia

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

Intensive Care Medicine Nepean Hospital NBMLHD The University of Sydney Sydney Australia

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

Réanimation Polyvalente CHU Dupuytren 2 Ave Martin Luther King 87042 Limoges Cedex 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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