**Supplementary Materials:** The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jcm11092625/s1, Video S1: RV-LSF in TEE by the QLAB software; Video S2: RV-FWLS and RV-GLS in TEE by the QLAB software. Figure S1: Range of RVsD according to the echocardiographic definition.

**Author Contributions:** Conceptualization, C.B., O.A.-A. and Y.M.; methodology, C.B., V.J. and H.D.; formal analysis, C.B. and A.H.; investigation, C.D., T.B., T.G., M.C. and N.M.; writing—original draft preparation, C.B., C.D. and A.H.; writing—review and editing, C.B., P.H., O.A.-A. and Y.M.; supervision, O.A.-A. and Y.M. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Amiens University Hospital IRB (Comité de Protection des Personnes Nord-Ouest II CHU-Place V. Pauchet, 80054 AMIENS Cedex 1, CNIL Number: PI2020_843_0026) for studies involving humans.

**Informed Consent Statement:** Informed consent was waived by French law on clinical research for non-interventional studies. However, oral and written information was still provided whenever possible to the patients and systematically to their families, specifying that they could oppose us using their data [34].

**Data Availability Statement:** The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

**Acknowledgments:** We thank the medical, paramedical, and research staff of the Anesthesiology and Critical Department of Amiens University Hospital.

**Conflicts of Interest:** The authors declare no conflict of interest.

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<figure><img src="image_31.png" /></figure>
ASSOCIATION ENTRE LA FRACTION DE RACCOURCISSEMENT LONGITUDINAL DU VENTRICULE DROIT ET LA MORTALITE DU SYNDROME DE DETRESSE RESPIRATOIRE AIGUE LIE A L'INFECTION AU COVID-19

**Introduction** : Dans le syndrome de détresse respiratoire aigu secondaire (SDRA) au COVID-19, la présence d'une dysfonction systolique ventriculaire droite est associée à une augmentation de mortalité. Le ventricule droit est influencé par les techniques de suppléance respiratoire, et nécessite une surveillance échocardiographique rapprochée. Contrairement aux marqueurs conventionnels, la fraction de raccourcissement longitudinale du ventricule droit (RV-LSF) est un paramètre issu du speckle tracking bidimensionnel utilisable en échographie transoesophagienne (ETO), angle-indépendant, reproductible et d'obtention rapide. L'objectif de notre étude est d'évaluer l'association entre l'altération du RV-LSF et la mortalité à 30 jours chez les patients atteints de SDRA COVID.

**Méthodes** : Les patients atteints d'un SDRA COVID modéré à sévère sous ventilation mécanique ayant bénéficié d'une ETO dans les 48 heures après leur admission en Réanimation au Centre Hospitalier d'Amiens étaient inclus. Ils étaient divisés en deux groupes selon la présence d'une dysfonction droite, définie par un RV-LSF < 20%. Les facteurs de risque clinique et échographiques d'évolution vers la mortalité à 30 jours étaient évalués.

**Résultats** : Entre le 28 février 2020 et le 1er décembre 2021, 86 patients ont été inclus. 43% (n=37/86) présentaient une dysfonction droite et 22% (n=19/86) décédaient à 30 jours. La mortalité était plus élevée dans le groupe dysfonction droite (15/37 vs 4/49, p =0,0001). Dans le modèle de Cox multivarié, le RV-LSF < 20% était le seul paramètre échocardiographique indépendamment associé à la mortalité (HR 4.45, 95% CI [1,43-13,8], p=0,01).

**Conclusion** : Dans le SDRA modéré à sévère secondaire au COVID-19, la dysfonction systolique ventriculaire droite définie un RV-LSF < 20% était associée à une augmentation de la mortalité à 30 jours.

**Mots-clés** : speckle tracking, ventricule droit, ETO, SDRA, COVID-19.

ASSOCIATION BETWEEN THE RIGHT VENTRICULAR LONGITUDINAL SHORTENING FRACTION AND MORTALITY IN ACUTE RESPIRATORY DISTRESS SYNDROME RELATED TO COVID-19 INFECTION

**Introduction:** Right ventricular systolic dysfunction (RVsD) increases acute respiratory distress syndrome mortality in COVID-19 infection (CARDS). As mechanical ventilation affects right ventricle, cardiac monitoring especially by transesophageal echocardiography (TEE) is useful. The RV longitudinal shortening fraction (RV-LSF) is an angle-independent, reproducible and automatically calculated bidimensional speckle-tracking parameter. We explored the association between RV-LSF and 30-day mortality in CARDS patients.

**Methods:** Moderate-to-severe CARDS hospitalized at Amiens University Hospital with transesophageal echocardiography performed within 48 hours of intensive care unit admission were included. Patients were divided into two groups according to the presence of RVsD, defined by an RV-LSF < 20%. Clinical and echocardiographic risk factors predicting 30-day mortality were evaluated.

**Results:** Between February 28th, 2020, and December 1st, 2021, 86 patients were included. 43%(n=37/86) showed RVsD and 22% (n=19/86) patients died. 30-day mortality was higher in the RVsD group (15/37 vs.4/49, P=0.001). In a multivariable Cox model, RV-LSF was the only echocardiographic factor independently associated with mortality (HR 4.45, 95%CI [1.43-13.8], P=0.01).

**Conclusion:** In a cohort of moderate-to-severe CARDS under mechanical ventilation, RVsD defined by the RV-LSF was associated with higher 30-days mortality.

**Keywords:** speckle tracking, right ventricle, TEE, ARDS, COVID-19.