Right ventriculoarterial coupling as a predictor of mortality in patients with COVID-19
Authors: Miranda Aquino T , Pereira-Forcado J , Ordonez-Salazar B , Dominguez-Trejo G , Martinez-Castillo J , Vazquez-Orozco RJ , Guevara-Canseco P , Perez-Topete SE , Rangel-Guerra A , Amezcua-Gomez L , Aceves-Millan R , Ixcamparij-Rosales C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Myocardial damage has been widely described in patients with COVID-19. Right ventriculoarterial coupling (RVAC) is a marker of subclinical myocardial damage. The association with mortality in COVID-19 patients has been recently investigated.

Objectives
To determine if there is a difference in patients with abnormal vs normal RVAC, in clinical, laboratory and echocardiographic variables. Analyze if there is an association between the presence of abnormal RVAC and one-year mortality. Investigate the cutoff value of the RVAC to predict mortality.

Methods.
A single-center, prospective, analytical study. Patients with a diagnosis of COVID-19 were included. Patients who were on mechanical ventilation during the study, a history of ischemic heart disease, valvular heart disease, and chronic obstructive pulmonary disease were excluded. The patients were included during the period from May to August 2020, the 1-year follow-up was carried out through the electronic medical record and telephone calls. The echocardiograms were performed with the Phillips IE-33, the strain determination was obtained with the Qlab 13.0 software. The quantitative variables were compared with the Student"s T test or the U Mann-Whitney test, according to the normality of the variables; qualitative variables were contrasted with the x2 test. One-year survival was determined with the Kaplan-Meier curves, and the association with one-year mortality was investigated with Cox regression. The cut-off value for predicting mortality was determined with ROC curves. The RVAC was determined with the right ventricular free wall longitudinal strain / pulmonary systolic artery pressure ratio. Abnormal right ventriculoarterial coupling was determined with a value less than 0.8.

Results
81 patients were included, of whom 45 had an abnormal RVAC. Patients with abnormal RVAC had higher mortality and a higher requirement for mechanical ventilation; they had higher levels of biomarkers. Among the echocardiographic variables, they had lower the right ventricular fractional area change, the tricuspid annular plane systolic excursion, the left ventricular longitudinal strain, the left atrial reservoir strain, the right ventricular free wall longitudinal strain, the RVAC; while they also presented higher the pulmonary systolic artery pressure and the tricuspid regurgitation velocity. The one-year survival of patients with abnormal RVAC was 53% vs 91%, the association with 1-year mortality was HR: 7.0 (CI95 2.1-23; p = 0.0001). The cutoff value of the RVAC to predict mortality was &lt;0.48 (Sensitivity 71%, Specificity 90%, AUC: 0.836; p = &lt;0.0001).

Conclusion
The patients with COVID-19 and an abnormal RVAC had a higher requirement for mechanical ventilation and mortality; presented higher levels of biomarkers. Half of the patients with abnormal RVAC died, presenting an association to predict mortality. The cut-off value of &lt;0.48 was the best associated with mortality. Abstract Table 1 Abstract Figure 1