Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome

Abstract

Introduction: Rapid spread of COVID-19 has caused detrimental effects globally. Involvement of the ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH), were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and their association with COVID-19 clinical outcome. Material and methods: A systematic data search was conducted through PubMed, medRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using RevMan v.5.4 and Stata v.16. Results: A total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95% CI: 13–25%), and PH was 22% (95% CI: 14–31%). RVD was associated with increased mortality (OR = 2.98 (95% CI: 1.50–5.89), p = 0.002), severity (OR = 3.61 (95% CI: 2.05–6.35), p < 0.001), ICU admission (OR = 1.70 (95% CI: 1.12–2.56), p = 0.01), and mechanical ventilation (MV) usage (OR = 1.60 (95% CI: 1.14–2.25), p = 0.007). PH was also associated with increased mortality (OR = 5.42 (95% CI: 2.66–11.060, p < 0.001), severity (OR = 5.74 (95% CI: 2.28–14.49), p < 0.001), and ICU admission (OR = 12.83 (95% CI: 3.55–46.41), p < 0.001). Conclusions: RVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.