Ultrasound Insights: Right Ventricular Performance in COVID-19 ARDS and Systo-Diastolic Interaction

The cardiac effects of COVID-19 in critically ill patients with acute respiratory distress syndrome (ARDS) have been widely documented, particularly among those admitted to the intensive care unit (ICU). While much attention has been given to left ventricular (LV) and right ventricular (RV) systolic dysfunction, the role of RV diastolic function and system-diastolic interaction remains underexplored. This study evaluates the prevalence of RV diastolic dysfunction, using the pulmonary valve pre-ejection A wave (PV A wave), and RV systo-diastolic interaction, assessed through total isovolumic time (t-IVT), in patients with COVID-19-related ARDS. Conducted as a prospective observational study, it enrolled 163 patients with moderate to severe COVID-19 ARDS. Transthoracic echocardiograms (TTEs) were performed within 24 hours of ICU admission and repeated during the ICU stay when clinical conditions warranted. Results showed that 22.1% of patients had RV dysfunction, 27.1% had LV dysfunction, and 44.7% exhibited the PV A wave. RV t-IVT correlated significantly with TAPSE, peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), dynamic driving pressure (DDP), and PaO2/FiO2 ratios. Similarly, the presence of PV A wave was linked to higher PIP, PEEP, DDP, and lower PaO2/FiO2 ratios. These findings suggest that RV t-IVT and PV A wave presence provide valuable non-invasive markers for assessing RV diastolic dysfunction and overall performance in critically ill COVID-19 patients. This emphasizes the importance of diastolic evaluation and system-diastolic interactions in understanding RV function and optimizing care for patients with severe COVID-19 ARDS.