Prognostic impact of right ventricular dilatation and echocardiography use criteria in hospitalized COVID-19 patients

doi:10.5662/wjm.v16.i3.117845

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World Journal of Methodology

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2222-0682

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Methodol. Sep 20, 2026; 16(3): 117845
Published online Sep 20, 2026. doi: 10.5662/wjm.v16.i3.117845

Prognostic impact of right ventricular dilatation and echocardiography use criteria in hospitalized COVID-19 patients

Arnold Méndez-Toro, Ingrid Tatiana Rojas-Ruiz, Luis Eduardo Silva-DiazGranados, Andrés Ruano-Cadena, Manuel Agustín Paz-Meneses, Ricardo Andrés Novoa-Alvarez

Arnold Méndez-Toro, Department of Cardiology, Hospital Universitario Nacional de Colombia/Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia

Ingrid Tatiana Rojas-Ruiz, Faculty of Nursing, Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia

Luis Eduardo Silva-DiazGranados, Department of Cardiology, Sigandini, Bogota 110110, Bogotá, Colombia

Andrés Ruano-Cadena, Internal Medicine, Universidad Nacional de Colombia, Bogota 110110, Bogotá, Colombia

Manuel Agustín Paz-Meneses, Department of Cardiology, Clinica Colombia, Bogota 110110, Bogotá, Colombia

Ricardo Andrés Novoa-Alvarez, Research and Innovation Center, Navarra University Foundation, Neiva 410001, Huila, Colombia

Co-corresponding authors: Arnold Méndez-Toro and Ricardo Andrés Novoa-Alvarez.

Author contributions: Méndez-Toro A contributed to conceptualization, methodology, project administration, supervision, and writing-review and editing; Rojas-Ruiz IT contributed to data curation, formal analysis, software, and validation; Luis Eduardo Silva-DiazGranados LE contributed to investigation, validation, and writing-original draft; Ruano-Cadena A contributed to conceptualization, investigation, formal analysis, data curation, and writing-original draft; Paz-Meneses MA contributed to investigation, resources, and writing-review and editing; Novoa-Alvarez RA contributed to formal analysis, methodology, software, validation, and writing-review and editing; Méndez-Toro A and Novoa-Alvarez RA have played important and indispensable roles in the manuscript preparation as the co-corresponding authors.

AI contribution statement: The author employed translation (using DeepL) and language editing tools (Grammarly). All the research findings, data collection, and clinical interpretations were original and completed independently by the author.

Institutional review board statement: The study protocol received formal approval from the Institutional Research Ethics Committee of the Hospital Universitario Nacional de Colombia and was performed in strict accordance with the principles of the Declaration of Helsinki.

Informed consent statement: As this investigation was classified as a minimal-risk documentary study based exclusively on the secondary analysis of anonymized electronic medical records, the committee granted a waiver of informed consent.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this study. No financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work exist.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available due to institutional data protection policies and the ethical restrictions established by the Institutional Research Ethics Committee to protect patient confidentiality.

Corresponding author: Arnold Méndez-Toro, MD, Professor, Department of Cardiology, Hospital Universitario Nacional de Colombia/Universidad Nacional de Colombia, Cl. 44 #59-75, Bogota 111321, Bogotá, Colombia. arnold.mendez@hun.edu.co

Received: December 18, 2025
Revised: January 20, 2026
Accepted: February 11, 2026
Published online: September 20, 2026
Processing time: 205 Days and 13.7 Hours

Abstract

BACKGROUND

The surge of severe acute respiratory syndrome coronavirus 2 [coronavirus disease 2019 (COVID-19)] infection created unprecedented diagnostic and logistical pressures. Given the established potential for cardiac injury and the critical need to optimize scarce resources, establishing the clinical utility and prognostic value of transthoracic echocardiography (TTE) became imperative.

AIM

To evaluate the prognostic predictors and the adherence to appropriate use criteria (AUC) for TTE in a highly affected setting.

METHODS

We performed a retrospective cohort study analyzing records from patients with confirmed COVID-19 who underwent TTE. Socio-demographic, biochemical, and echocardiographic parameters were collected. Mortality was the primary outcome. We assessed inter-observer agreement (Kappa statistic) for TTE indications (based on American College of Cardiology Foundation 2011 and American Society of Echocardiography 2020 guidelines) and the determination of clinical impact (a subsequent change in patient management).

RESULTS

Total 149 patients were analyzed. Median age was 66 years [interquartile range (IQR): 56-73], median hospital stay was 13 days (IQR: 6-23). Overall and intensive care unit mortality rates were 39.6% and 60%, respectively. Elevated biochemical markers (leukocytes, neutrophils, lactate dehydrogenase, and C-reactive protein) were associated with mortality. Crucially, right ventricular (RV) dilatation and/or strain (P = 0.008) was identified as the sole echocardiographic finding significantly predictive of mortality. Inter-observer agreement for classifying AUC was high (κ ≥ 0.798). Furthermore, TTE prompted a change in clinical management in 79.7% of the cases.

CONCLUSION

RV pathology is a potent, quantifiable prognostic indicator. While AUC demonstrated high reliability, the significant and frequent changes in management suggest that the current guidelines may possess inherent limitations when addressing the unique, acute prognostic complexities of severe COVID-19 disease.

Keywords: SARS-CoV-2; COVID-19; Echocardiography; Prognosis; Right ventricular strain; Appropriate use criteria

Core Tip: This study highlights right ventricular dilatation as the primary echocardiographic predictor of mortality in hospitalized coronavirus disease 2019 patients. While adherence to appropriate use criteria for transthoracic echocardiography (TTE) was exceptionally high (98%), the immediate clinical impact on management remained modest (12.7%). These findings suggest that during pandemics, TTE is a robust prognostic tool; however, its systematic use should be further refined to maximize therapeutic yield. This research provides a data-driven foundation for optimizing cardiac imaging resources and developing future artificial intelligence models for risk stratification in acute viral infections.