Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes

Ran Tao; Zuzana Burivalova; S Carolina Masri; Naga Dharmavaram; Aurangzeb Baber; Roderick Deaño; Timothy Hess; Ravi Dhingra; James Runo; Nizar Jarjour; Rebecca R Vanderpool; Naomi Chesler; Joanna E Kusmirek; Marlowe Eldridge; Christopher Francois; Farhan Raza

doi:10.1186/s43044-022-00274-w

Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes

Egypt Heart J. 2022 May 8;74(1):37. doi: 10.1186/s43044-022-00274-w.

Authors

Ran Tao¹, Zuzana Burivalova², S Carolina Masri^{1

3}, Naga Dharmavaram^{1

3}, Aurangzeb Baber^{1

3}, Roderick Deaño^{1

3}, Timothy Hess³, Ravi Dhingra^{1

3}, James Runo^{1

4}, Nizar Jarjour^{1

4}, Rebecca R Vanderpool⁵, Naomi Chesler⁶, Joanna E Kusmirek⁷, Marlowe Eldridge⁸, Christopher Francois⁹, Farhan Raza^{10

11}

Affiliations

¹ Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
² Nelson Institute for Environmental Studies, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
³ Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
⁴ Department of Medicine-Division of Pulmonary and Critical Care, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
⁵ Department of Biomedical Engineering, The University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ, 85721, USA.
⁶ Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA, 92697, USA.
⁷ Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
⁸ Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
⁹ Mayo Clinic Radiology, 200 First St. SW, Rochester, MN, 55905, USA.
¹⁰ Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA. fraza@medicine.wisc.edu.
¹¹ Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA. fraza@medicine.wisc.edu.

Abstract

Background: Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease.

Results: We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1.

Conclusions: In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.

Keywords: COVID-19; Chest CT-angiogram; RV:LV ratio; Right ventricular dilation.

Abstract

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