May 20, 2020
The enlargement of the heart's right ventricle appears to be the strongest indicator that a COVID-19 patient is more likely to die of the illness, according to a study conducted by the Ichan School of Medicine at Mount Sinai.
The study's findings are based on the health records of 105 patients hospitalized at Mount Sinai Morningside in New York City between March 26 and April 22. Heart ultrasounds revealed that 31 of them had a dilated right ventricle.
By the end of the study, 41% of the patients with right ventricle enlargement had died. Only 11% of patients without an enlarged right ventricle had died.
The right ventricle is one of the four chambers of the heart. It receives deoxygenated blood from the right atrium and pumps into the lungs. Right ventricular enlargement prevents the heart from functioning efficiently, increasing a patient's risk of heart failure.
The patients with right ventricular enlargement did not have any significant difference in other variables. That includes major co-morbidities like coronary artery disease, hypertension, diabetes, inflammation and myocardial injury, an imbalance in the supply and demand of oxygen to the heart.
The average age of the patients was 66 years old; 38 were female and 31 were on a ventilator at the time of examination.
"This study provides important evidence associating right heart strain with adverse outcomes in hospitalized patients with COVID-19 infection," Dr. Edgar Argulian, an assistant professor of medicine said in a statement. "Clinicians can use bedside echocardiography as a readily available tool to identify patients with COVID-19 infection at the highest risk of adverse hospital outcomes."
Other doctors also have observed the relationship between right ventricular strain and mortality in COVID-19 patients. A case report in the New England Journal of Medicine described the same phenomenon in five patients with severe disease.
The driving factors behind this connection are not clear.
The study's authors suggest the coronavirus may be acting directly on the heart. But they also noted the damage could be related to blood flow restrictions caused by blood clots or lung injury.
Other studies have found that the coronavirus can spread to the heart through the ACE2 receptors in cardiac muscle cells, according to the American Heart Association.
The study has been accepted for publication in the Journal of the American College of Cardiology.