Right ventricular (RV) involvement
RV involvement seems to be the most common with multiple studies
demonstrating RV dilatation and a range of systolic dysfunction from
mild to severe including documented instance of an acute cor pulmonale
like presentation [16–21]. Pulmonary artery systolic pressure
(PASP) was also found to be significantly elevated in a large number of
patients presenting with COVID-19[4,18]. These findings may in part
be attributed to a hypercoagulable state associated with systematic
inflammation , endothelial dysfunction of the pulmonary vasculature
leading to pulmonary emboli or microthrombi affecting the smaller
segmental pulmonary arteries, hypoxemia secondary to infection itself or
adverse effects of positive pressure ventilation[4,18,22–25].
Further, tricuspid annular plane systolic excursion (TAPSE) was found to
be significantly decreased in critically ill COVID-19 patients and was
more profoundly affected in severe acute respiratory distress syndrome
(ARDS) as compared to mild ARDS and was found to have the best
inter-observer variability [26](51). A study by D‘Alto et al.
demonstrated that right ventricular-arterial uncoupling expressed as
TAPSE/PASP is an independent predictor of mortality in COVID-19 patients
[27].