COVID-19 ve sağ ventrikül disfonksiyonu: Güncel tedavi stratejileri ve ekokardiyografik bulgular

Year 2021, Volume: 2 Issue: 2, 60 - 64, 30.06.2021

Ufuk Öztürk

Abstract

Tüm insanlığı etkileyen yeni bir hastalık Aralık 2019 Wuhan’da başlayıp 11 Şubat 2020 tarihinde Dünya Sağlık Örgütü tarafından Ciddi Akut Solunumsal Sendrom-Koronavirüs-2 olarak isimlendirilmiş ve Koronavirüs Hastalığı 2019 (COVID-19) olarak literatüre eklenmiştir. Hastalık üst ve alt solunum yolu tutulumunun yanında kardiyak, vasküler ve tromboembolik komplikasyonları mevcuttur. Konu ile ilgili güncel çalışmalar devam etmekle beraber, COVID-19 tanımlandığından beri tüm dünyada sağlık sistemini ve yoğun bakım pratiğini temelinden değiştiren bir olgu haline gelmiştir. Hastalığın kısa dönem sonuçları aydınlanmaya başlamış iken, orta ve uzun dönem sonuçları halen net olarak ortaya konamamıştır. Özellikle COVID-19 pnömonisi ve akut respiratuvar distres sendromu tablosu olan hastalarda gelişen sağ ventrikül disfonksiyonu, günlük kardiyoloji pratiğinde bu hasta grubunun daha sık karşımıza çıkmasına neden olmaktadır. Bu derlemenin amacı COVID-19 hastalığı esnasında ortaya çıkan sağ ventrikül disfonksiyonunun patofizyolojisini, tanı ve tedavi önerilerini güncel literatür bilgileri ışığında yeniden ele almaktır.

Keywords

Sağ ventrikül, COVID-19, SARS-CoV-2, sağ kalp yetmezliği

COVID-19 and right ventricular dysfunction: A review of current treatment strategies and echocardiographic findings

Abstract

A new disease affecting all humanity started in December 2019 in Wuhan, and was named as Serious Acute Respiratory Syndrome-Coronavirus-2 by the World Health Organization on February 11, 2020, which was added to the literature as Coronavirus Disease 2019 (COVID-19). The disease has become a phenomenon with cardiac, vascular and thromboembolic complications besides upper and lower respiratory tract involvement. Studies on the disease continue and the disease has changed the healthcare system and intensive care practice to the foundation since it was identified. Although the short-term consequences of the disease have begun to be enlightened, especially the medium-term and long-term consequences of it remain a mystery. The right ventricle dysfunction which develops especially in patients with COVID-19 pneumonia and acute respiratory distress syndrome picture, brings this patient group to the daily cardiology practice more often. This review aims to reveal the pathophysiology, diagnosis and treatment recommendations of the right ventricle dysfunction which appears during the COVID-19 disease, in the light of the up-to-date literature.

Keywords

right ventricle, COVID-19, SARS-CoV-2, Right heart failure

References

• 1. Gupta A, Madhavan MV, Sehgal K, et al. Extrapulmonary manifestations of COVID 19. Nat Med 2020;26(7):1017-32.
• 2. Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020;367(6483):1260-3.
• 3. Zeng JH, Wu WB, Qu JX, et al. Cardiac manifestations of COVID-19 in Shenzhen, China. Infection 2020;48(6): 861-70.
• 4. Argulian E, Sud K, Vogel B, et al. Right ventricular dilation in hospitalized patients with COVID-19 infection. JACC Cardiovasc Imaging 2020;13(11):2459-61.
• 5. Szekely Y, Lichter Y, Taieb P, et al. Spectrum of cardiac manifestations in COVID-19: A systematic echocardiographic study. Circulation 2020;142(4):342-53.
• 6. Isgro G, Yusuff HO, Zochios V. The right ventricle in COVID-19 lung injury: Proposed mechanisms, management, and research gaps. Cardiothorac Vasc Anesth 2021;35(6):1568-72.
• 7. Caravita S, Baratto C, Di Marco F, et al. Haemodynamic characteristics of COVID-19 patients with acute respiratory distress syndrome requiring mechanical ventilation. An invasive assessment using right heart catheterization. European Journal of Heart Failure 2020;22(12):2228-37.
• 8. Schmitt J-M, Vieillard-Baron A, Augarde R, Prin S, Page B, Jardin F. Positive end-expiratory pressure titration in acute respiratory distress syndrome patients: Impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements. Crit Care Med 2001;29(6):1154-8.
• 9. Mekontso Dessap A, Boissier F, Charron C, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: Prevalence, predictors, and clinical impact. Intensive Care Medicine 2016;42(5):862-70.
• 10. Bösmüller H, Traxler S, Bitzer M, et al. The evolution of pulmonary pathology in fatal COVID-19 disease: An autopsy study with clinical correlation. Virchows Archiv 2020;477(3):349-57.
• 11. Dolhnikoff M, Duarte-Neto AN, De Almeida Monteiro RA, et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost 2020;18(6):1517-9.
• 12. Gallastegui N, Zhou JY, Drygalski AV, Barnes RFW, Fernandes TM, Morris TA. Pulmonary embolism does not have an unusually high incidence among hospitalized COVID-19 patients. Clinical and Applied Thrombosis/Hemostasis 2021;27:1076029621996471.
• 13. Doyen D, Dupland P, Morand L, et al. Characteristics of cardiac injury in critically ill patients with coronavirus disease 2019. Chest 2021;159(5):1974-85.
• 14. García-Cruz E, Manzur-Sandoval D, Rascón-Sabido R, et al. Critical care ultrasonography during COVID-19 pandemic: The ORACLE protocol. Echocardiography 2020;37(9):1353-61.
• 15. García-Cruz E, Manzur-Sandoval D, Baeza-Herrera LA, et al. Acute right ventricular failure in COVID-19 infection: A case series. J Cardiol Cases 2021 Jan 18. [Epub ahead of print.] doi: 10.1016/j.jccase.2021.01.001.
• 16. Mahmoud-Elsayed HM, Moody WE, Bradlow WM, et al. Echocardiographic findings in patients with COVID-19 pneumonia. Canadian Journal of Cardiology 2020;36(8):1203-7.
• 17. D’Alto M, Marra AM, Severino S, et al. Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS. Crit Care 2020;24(1):670.
• 18. Schott JP, Mertens AN, Bloomingdale R, et al. Transthoracic echocardiographic findings in patients admitted with SARS-CoV-2 infection. Echocardiography 2020;37(10):1551-6.
• 19. Goudot G, Chocron R, Augy JL, et al. Predictive factor for COVID-19 worsening: Insights for high-sensitivity troponin and D-dimer and correlation with right ventricular afterload. Front Med (Lausanne) 2020;7:586307.
• 20. Lang RM, Badano LP, Victor MA, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28(1):1-39.e14.
• 21. Bleakley C, Singh S, Garfield B, et al. Right ventricular dysfunction in critically ill COVID-19 ARDS. Int J Cardiol 2021;327:251-8.
• 22. Martha JW, Pranata R, Wibowo A, Lim MA. Tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography and mortality in COVID-19: A systematic review and meta-analysis. Int J Infect Dis 2021;105:351-6.
• 23. Bursi F, Santangelo G, Sansalone D, et al. Prognostic utility of quantitative offline 2D-echocardiography in hospitalized patients with COVID-19 disease. Echocardiography 2020;37(12):2029-39.
• 24. Beyls C, Bohbot Y, Huette P, Abou-Arab O, Mahjoub Y. Tricuspid longitudinal annular displacement for the assessment of right ventricular systolic dysfunction during prone positioning in patients with COVID-19. J Am Soc Echocardiogr 2020;33(8):1055-7.
• 25. Zhang Y, Sun W, Wu C, et al. Prognostic value of right ventricular ejection fraction assessed by 3d echocardiography in COVID-19 patients. Front Cardiovasc Med 2021;8:641088.
• 26. Paternot A, Repessé X, Vieillard-Baron A. Rationale and description of right ventricle-protective ventilation in ARDS. Respiratory Care 2016;61(10):1391-6.
• 27. Zochios V, Parhar K, Vieillard-Baron A. Protecting the right ventricle in ARDS: The role of prone ventilation. J Cardiothorac Vasc Anesth 2018;32(5):2248-51.
• 28. Kobayashi J, Murata I. Nitric oxide inhalation as an interventional rescue therapy for COVID-19-induced acute respiratory distress syndrome. Ann Intensive Care 2020;10(1):61.
• 29. Schmidt M, Hajage D, Lebreton G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study. Lancet Respir Med 2020;8(11):1121-31.
• 30. Barbaro RP, MacLaren G, Boonstra PS, et al. Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization registry. Lancet 2020;396(10257):1071-8.
• 31.Tatooles AJ, Mustafa AK, Alexander PJ, et al. Extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure. JAMA Surg 2020;155(10): 990-2.