Association between right ventricular dysfunction and in-hospital mortality in surges of SARS-CoV-2 infection attributed to the Alpha, Delta, and Omicron variants

Alaa Mabrouk Salem Omar; Nolberto Hernandez; Diana Maria Ronderos Botero; Angel Delacruz; Sai Doppalapudi; Vikram Itare; Dongmin Shin; Jaydeep Mahasamudram; Neelanjana Pandey; Nishant Allena; Karan Sud; Sridhar Chilimuri; Jonathan N Bella

doi:10.1016/j.ijcha.2022.101150

Association between right ventricular dysfunction and in-hospital mortality in surges of SARS-CoV-2 infection attributed to the Alpha, Delta, and Omicron variants

Int J Cardiol Heart Vasc. 2022 Dec:43:101150. doi: 10.1016/j.ijcha.2022.101150. Epub 2022 Nov 17.

Authors

Alaa Mabrouk Salem Omar^{1

2}, Nolberto Hernandez^{2

3}, Diana Maria Ronderos Botero^{2

4}, Angel Delacruz^{2

3}, Sai Doppalapudi^{2

3}, Vikram Itare^{2

3}, Dongmin Shin^{2

3}, Jaydeep Mahasamudram^{2

3}, Neelanjana Pandey^{2

3}, Nishant Allena^{2

3}, Karan Sud^{1

2}, Sridhar Chilimuri^{2

3}, Jonathan N Bella^{2

5}

Affiliations

¹ Department of Cardiology, Mount Sinai Morningside, New York, NY, USA.
² Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Department of Medicine, BronxCare Hospital Center, Bronx, NY, USA.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, BronxCare Hospital Center, Bronx, NY, USA.
⁵ Department of Cardiology, BronxCare Hospital Center, Bronx, NY, USA.

Abstract

Background: Right ventricular (RV) dysfunction in acute COVID-19 was reported to be associated with poor prognosis. We studied the association between parameters of RV dysfunction and in-hospital mortality during the surges caused by different SARS-CoV-2 variants.

Methods: In a retrospective single-center study, we enrolled 648 consecutive patients hospitalized with COVID-19 [66 (10 %) hospitalized during the alpha variant surge, 433 (67 %) during the delta variant surge, and 149 (23 %), during the omicron variant surge]. Patients were reported from a hospital with an underreported population of mostly African American and Hispanic patients. Patients were followed for a median of 11 days during which in-hospital death occurred in 155 (24 %) patients [Alpha wave: 25 (38 %), Delta Wave: 112 (26 %), Omicron wave: 18 (12 %), p < 0.001].

Results: RV dysfunction occurred in 210 patients (alpha: 32 %, 26 %, delta: 29 %, and omicron: 49 %, p < 0.001) and was associated with higher mortality across waves, however, independently predicted in-hospital mortality in the Alpha (HR = 5.1, 95 % CI: 2.06-12.5) and Delta surges (HR = 1.6, 95 % CI: 1.11-2.44), but not in the Omicron surge. When only patients with RV dysfunction were compared, the mortality risk was found to decrease significantly from the Alpha (HR = 13.6, 95 % CI: 3.31-56.3) to the delta (HR = 1.93, 95 % CI: 1.25-2.96) and to the Omicron waves (HR = 11, 95 % CI: 0.6-20.8).

Conclusions: RV dysfunction continues to occur in all strains of the SARS-CoV-2 virus, however, the mortality risk decreased from wave to wave likely due to evolution of better therapeutics, increase rate of vaccination, or viral mutations resulting in decrease virulence.Registration number of clinical studies: BronxCare Hospital center institutional review board under the number 05 13 21 04.

Keywords: COVID-19; Mortality; RV dysfunction.