RV Dysfunction Slams Survival in Acute COVID, Flu, Pneumonia

Abdullah Hashmi, MD, for Medscape

July 18, 2022

The study covered in this summary was published in medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Right ventricular (RV) dilation or dysfunction in patients hospitalized with acute COVID-19 is associated with an elevated risk for in-hospital death.

  • The impact of RV dilation or dysfunction on in-hospital mortality is similar for patients with acute COVID-19 and those with influenza, pneumonia, or acute respiratory distress syndrome (ARDS), but COVID-19 patients have greater absolute in-hospital mortality.

  • RV dilatation or dysfunction in patients with acute COVID-19 is associated with a diagnosis of venous thromboembolism and subsequent intubation and mechanical ventilation.

Why This Matters

  • Right ventricular dysfunction increases mortality risk in acute COVID-19, and this study shows that RV dilation and dysfunction among such hospitalized patients has a similar impact on risk for in-hospital death in acute COVID-19 and in other respiratory illnesses.

  • The findings suggest that abnormal RV findings should be considered a mortality risk marker in patients with acute respiratory illness, especially COVID-19.

Study Design

  • The retrospective study involved 225 consecutive patients admitted for acute COVID-19 from March 2020 to February 2021 at four major hospitals in the same metropolitan region and a control group of 6150 adults admitted to the hospital for influenza, pneumonia, or ARDS; mean age in the study cohort was 63 years.

  • All participants underwent echocardiography during their hospitalization, including evaluation of any RV dilation or dysfunction.

  • Associations between RV measurements and in-hospital mortality, the primary outcome, were adjusted for potential confounders.

Key Results

  • Patients in the COVID-19 group were more likely than those in the control patients to be male (66% vs 54%; P < .001), to identify as Hispanic (38% vs 15%; P < .001), and to have a higher mean body mass index (29.4 vs 27.9 kg/m2; P = .008).

  • Compared with the control group, patients in the COVID-19 group more often required admission to the intensive-care unit (75% vs 54%; P < .001), mechanical ventilation (P < .001), and initiation of renal replacement therapy (P = .002), and more often were diagnosed with deep-vein thrombosis or pulmonary embolism (25% vs 14%; P < .001). The median length of hospital stay was 20 days in the COVID-19 group, compared with 10 days in the control group (P < .001).

  • In-hospital mortality was 21.3% in the COVID-19 group and 11.8% in the control group (P = .001). Those hospitalized with COVID-19 had an adjusted relative risk (RR) of 1.54 (95% CI, 1.06 - 2.24; P = .02) for in-hospital mortality, compared with those hospitalized for other respiratory illnesses.

  • Mild RV dilation was associated with an adjusted RR of 1.4 (95% CI, 1.17 - 1.69; P = .0003) for in-hospital death, and moderate to severe RV dilation was associated with an adjusted RR of 2.0 (95% CI, 1.62 - 2.47; P < .0001).

  • The corresponding adjusted risks for mild RV dysfunction and greater-than-mild RV dysfunction were, respectively, 1.39 (95% CI, 1.10 - 1.77; P = .007) and 1.68 (95% CI, 1.17 - 2.42; P = .005).

  • The RR for in-hospital mortality associated with RV dilation and dysfunction was similar in those with COVID-19 and those with other respiratory illness, but the former had a higher baseline risk that yielded a greater absolute risk in the COVID-19 group.


  • The study was based primarily on a retrospective review of electronic health records, which poses a risk for misclassification. 

  • Echocardiography was performed without blinding operators to patient clinical status, and echocardiograms were interpreted in a single university hospital system, so were not externally validated.

  • Because echocardiograms obtained during hospitalization could not be compared with previous echocardiograms, it could not be determined whether any of the patients had pre-existing RV dilation or dysfunction.

  • Strain imaging was not feasible in many cases.


  • The study received no commercial funding.

  • The authors disclosed no financial relationships.

This is a summary of a preprint research study, Association of Right Ventricular Dilation and Dysfunction on Echocardiogram With In-Hospital Mortality Among Patients Hospitalized with COVID-19 Compared With Other Acute Respiratory Illness, written by researchers at the University of California, San Francisco, Department of Medicine, and Zuckerberg San Francisco General Hospital, Division of Cardiology.


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