Right Ventricular Dysfunction in Patients With COVID-19: a systematic review and meta-analysis

Abstract Objective This systematic review and meta-analysis aimed to describe the features of right ventricular impairment and pulmonary hypertension in COVID-19 and assess its effect on mortality. Design We carried out a systematic review and meta-analysis of observational studies. Setting We performed a search through Pubmed, the International Clinical Trials Registry Platform, and the Cochrane Library for studies reporting right ventricular dysfunction in COVID-19 patients and outcomes. Participants The search yielded 9 studies in which the appropriate data were available. Interventions Pooled odds ratio were calculated according to the random effects model. Measurements and Main Results Overall, 1450 patients were analyzed, half of them invasively ventilated. Primary outcome was mortality at the longest follow-up available. Mortality was 48.5% versus 24.7% in patients with or without right ventricular impairment, (n = 7, OR = 3.10; 95% CI 1.72 – 5.58; p = 0.0002), 56.3% versus 30.6%, in patients with or without right ventricular dilatation (n = 6; OR = 2.43; 95% CI 1.41 – 4.18; p = 0.001), and 52.9% versus 14.8% in patients with or without pulmonary hypertension, (n = 3; OR = 5.75; 95% confidence intervals 2.67 – 12.38; p Conclusion Mortality of COVID-19 patients requiring respiratory support and with a diagnosis of right ventricular dysfunction, dilatation or pulmonary hypertension, is high. Future studies should highlight the mechanisms of right ventricular derangement in COVID-19 while early detection of right ventricular impairment using ultrasound might be important to individualize therapies and improve outcomes.