Cardiac involvement in critically ill and mechanically ventilated patients with COVID-19 - a prospective, observational echocardiographic study

• Published in: American journal of cardiovascular disease 2021-01, Vol.11 (2), p.253-261
• Main Authors: Norden, Nina, Lundin, Erik O, Hagberg, Eva, Gao, Sinsia A, Hård Af Segerstad, Mathias, Nellgård, Bengt, Dalla, Keti
• Format: Article
• Language: English
• Subjects: Anestesi och intensivvård; Anesthesiology and Intensive Care; COVID-19; D-dimer; inhalation of milrinone; intensive care unit; Original; right ventricular failure
• ISSN: 2160-200X; 2160-200X

INTRODUCTIONIn this prospective, observational study, we have evaluated right (RV) and left (LV) ventricular function with echocardiography and correlated it to the levels of biomarkers, hs-TNT, NT-pro-BNP, D-dimer and fibrinogen. In a subgroup, we have evaluated the effect of inhaled milrinone on RV afterload and function. METHODSThirty-one ICU patients with COVID-19 in need of mechanical ventilation and norepinephrine infusion were prospectively included. Hemodynamic and respiratory variables were measured at the time of the echocardiographic examination and biomarkers were obtained on arrival at the ICU and then followed up routinely. Eight patients received inhaled aerosolized milrinone at a dose of 2.5 mg/hour. RESULTSThe most common echocardiographic pattern was RV dilation with or without systolic dysfunction, which was found in 62% of patients. Pulmonary acceleration time was abnormal in 55% and indices of RV systolic function, such as fractional area of change, RV strain, were abnormal in 30% and 31% of patients respectively. A cardiac index of < 2.5 l/min*m2 was seen in 58% of the patients. Left ventricular ejection fraction and global left ventricular strain were impaired in 10% and 16% respectively. The correlation between echocardiographic variables and cardiac biomarkers was poor. RV afterload correlated well to the levels of D-dimer. Milrinone inhalation did not improve RV function or afterload. CONCLUSIONRV dysfunction was the most common finding. The poor correlation to cardiac biomarkers argues against extensive myocardial involvement. The lack of improvement in RV function after milrinone inhalation suggests that the most likely cause of RV dysfunction is increased RV afterload caused by pulmonary thrombosis/embolism.