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The Right Ventricle in COVID-19.

ABSTRACT: Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop various cardiac complications, among which dysfunction of the right ventricle (RV) appears particularly common, especially in severe forms of the disease, and which is associated with a dismal prognosis. Echocardiographic studies indeed reveal right ventricular dysfunction in up to 40% of patients, a proportion even greater when the RV is explored with strain imaging echocardiography. The pathophysiological mechanisms of RV dysfunction in COVID-19 include processes increasing the pulmonary vascular hydraulic load and others reducing RV contractility, which precipitate the acute uncoupling of the RV with the pulmonary circulation. Understanding these mechanisms provides the fundamental basis for the adequate therapeutic management of RV dysfunction, which incorporates protective mechanical ventilation, the prevention and treatment of pulmonary vasoconstriction and thrombotic complications, as well as the appropriate management of RV preload and contractility. This comprehensive review provides a detailed update of the evidence of RV dysfunction in COVID-19, its pathophysiological mechanisms, and its therapy.

SUBMITTER: Bonnemain J

PROVIDER: S-EPMC8230058 | biostudies-literature |

REPOSITORIES: biostudies-literature

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The right treatment for the right ventricle.

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Pentraxin-3 and the right ventricle: the Multi-Ethnic Study of Atherosclerosis-Right Ventricle Study.

Project description:Pentraxin-3 (PTX3) is a protein mediator of innate immunity that is elevated in the setting of left heart disease and pulmonary arterial hypertension. The relationship between PTX3 and right ventricular (RV) structure and function is not known. We included men and women with magnetic resonance imaging assessment of RV structure and function and measurement of PTX3 from the Multi-Ethnic Study of Atherosclerosis, a study of individuals free of clinical cardiovascular disease. Multivariable linear regression estimated associations between PTX3 protein levels and RV measures after adjusting for demographic characteristics, anthropometrics, smoking status, diabetes mellitus, hypertension, and corresponding left ventricular (LV) parameters. Instrumental variable analysis exploiting Mendelian randomization was attempted using two-stage least squares regression. The study sample included 1,779 participants with available PTX3 levels, RV measures, and all covariables. Mean PTX3 level was 2.1 ng/mL. Higher PTX3 was independently associated with greater RV mass and larger RV end-diastolic volume with and without adjustment for the corresponding LV parameters or C-reactive protein (all P < .05). There was no association between PTX3 and RV ejection fraction or stroke volume. Single-nucleotide polymorphisms were not associated with PTX3 protein levels or RV measures after accounting for race. Instrumental variable analysis could not be reliably performed. Higher PTX3 protein levels were associated with greater RV mass and larger RV end-diastolic volume. These associations were independent of common cardiovascular risk factors and LV morphologic changes. Inflammation is associated with differences in the pulmonary circulation-RV axis in adults without clinical cardiovascular disease.

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Brachial artery diameter and the right ventricle: the Multi-Ethnic Study of Atherosclerosis-right ventricle study.

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Regional left ventricular systolic function and the right ventricle: the multi-ethnic study of atherosclerosis right ventricle study.

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Project description:The right and left sides of the human heart operate with a common timing and pump the same amount of blood. Therefore, the right ventricle (RV) presents a function that is comparable to the left ventricle (LV) in terms of flow generation; nevertheless, the RV operates against a much lower arterial pressure (afterload) and requires a lower muscular strength. This study compares the fluid dynamics of the normal right and left ventricles to better understand the role of the RV streamlined geometry and provide some physics-based ground for the construction of clinical indicators for the right side. The analysis is performed by image-based direct numerical simulation, using the immersed boundary technique including the simplified models of tricuspid and mitral valves. Results demonstrated that the vortex formation process during early diastole is similar in the two ventricles, then the RV vorticity rapidly dissipates in the subvalvular region while the LV sustains a weak circulatory pattern at the center of the chamber. Afterwards, during the systolic contraction, the RV geometry allows an efficient transfer of mechanical work to the propelled blood; differently from the LV, this work is non-negligible in the global energetic balance. The varying behavior of the RV, from reservoir to conduct, during the different phases of the heartbeat is briefly discussed in conjunction to the development of possible dysfunctions.

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