This preprint is under consideration at The International Journal of Cardiovascular Imaging. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research Article
Farhan Raza
University of Wisconsin-Madison Department of Medicine
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Purpose
Our study aimed to use chest CT-angiogram (CTA) to assess if right ventricular (RV) dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the novel coronavirus (COVID-19) infection.
Methods
We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n=100), and two control groups: normal subjects (n=10) and subjects with organizing pneumonia (n=10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view; and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level.
Results
Among the COVID-19 cohort, the mean age (±SD) was 55.1±14.9 years and 55% were female. A higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06±0.10, vs 0.95±0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6±9.0 vs 32.7±6.6), yet the RV:LV ratio was higher (1.06±0.14 vs 0.89±0.07). In ROC analysis, RV:LV ratio had an AUC= 0.707 with an optimal cut-off of RV:LV 1.1 as a predictor of adverse outcomes. In a validation cohort (n=25), an RV:LV ≥1.1 as a cut-off predicted adverse outcomes with an odds ratio of 76:1.
Conclusion
In COVID-19 patients, RV:LV ratio ≥1.1 on CTA-chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing towards a vascular and/or thrombotic injury in the lungs.
Keywords
COVID-19, Right ventricular dilation, RV:LV ratio, chest CT-angiogram
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CURRENT STATUS: Under Review
Version 1
Posted 11 Mar, 2021
No community comments so far
Review #? received
Received 06 Mar, 2021
Reviewers invited
Invitations sent on 03 Mar, 2021
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On 23 Feb, 2021
First submitted
On 22 Feb, 2021
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Subject Areas
Cardiac & Cardiovascular Systems
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This preprint is under consideration at The International Journal of Cardiovascular Imaging. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Farhan Raza
University of Wisconsin-Madison Department of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 11 Mar, 2021
No community comments so far
Review #? received
Received 06 Mar, 2021
Reviewers invited
Invitations sent on 03 Mar, 2021
Editor assigned
On 23 Feb, 2021
First submitted
On 22 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Purpose
Our study aimed to use chest CT-angiogram (CTA) to assess if right ventricular (RV) dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the novel coronavirus (COVID-19) infection.
Methods
We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n=100), and two control groups: normal subjects (n=10) and subjects with organizing pneumonia (n=10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view; and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level.
Results
Among the COVID-19 cohort, the mean age (±SD) was 55.1±14.9 years and 55% were female. A higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06±0.10, vs 0.95±0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6±9.0 vs 32.7±6.6), yet the RV:LV ratio was higher (1.06±0.14 vs 0.89±0.07). In ROC analysis, RV:LV ratio had an AUC= 0.707 with an optimal cut-off of RV:LV 1.1 as a predictor of adverse outcomes. In a validation cohort (n=25), an RV:LV ≥1.1 as a cut-off predicted adverse outcomes with an odds ratio of 76:1.
Conclusion
In COVID-19 patients, RV:LV ratio ≥1.1 on CTA-chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing towards a vascular and/or thrombotic injury in the lungs.
Figure 1
Figure 2
Figure 3
Figure 4
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