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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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

Table 1 Demographic and clinical characteristics of confirmed coronavirus disease 2019 patients, n (%)/median (25^th-75^th percentiles)

Variable	Total (n = 149)	ICU patients (n = 75)	Non-ICU patients (n = 74)	P value
Age (years)	66 (56-73)	66 (56-73)	64 (54-72)	0.450
Male sex	79 (53.0)	42 (56.0)	37 (50.0)	0.460
Body mass index (kg/m²)	26.8 (24-30)	27.2 (24-31)	26.4 (23-29)	0.310
Comorbidities
Hypertension	65 (43.6)	35 (46.7)	30 (40.5)	0.450
Obesity	37 (25.0)	21 (28.0)	16 (21.6)	0.370
Diabetes mellitus	31 (20.8)	18 (24.0)	13 (17.6)	0.340
Hypothyroidism	23 (15.4)	12 (16.0)	11 (14.9)	0.850
Chronic obstructive pulmonary disease	15 (10.1)	9 (12.0)	6 (8.1)	0.430
Smoking history	12 (8.1)	7 (9.3)	5 (6.8)	0.570
Chronic kidney disease	8 (5.4)	5 (6.7)	3 (4.1)	0.480
Ischemic heart disease	10 (6.7)	6 (8.0)	4 (5.4)	0.530
Heart failure (previous)	7 (4.7)	4 (5.3)	3 (4.1)	0.720

ICU: Intensive care unit.

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Table 2 Echocardiographic and clinical outcomes in confirmed coronavirus disease 2019 patients, n (%)/median (25^th-75^th percentiles)

Variable	Total (n = 149)	ICU patients (n = 75)	Non-ICU patients (n = 74)	P value
Echocardiographic findings
Left ventricular ejection fraction < 40%	12 (8.0)	7 (9.3)	5 (6.7)	0.560
Segmental wall motion abnormalities	15 (10.1)	9 (12.0)	6 (8.1)	0.430
Right ventricular dilatation/overload	40 (26.8)	26 (34.7)	14 (18.9)	0.033
Right ventricular dysfunction (TAPSE < 17 mm)	9 (6.0)	6 (8.0)	3 (4.1)	0.310
PASP > 35 mmHg	134 (89.9)	69 (92.0)	65 (87.8)	0.390
Left atrial enlargement	15 (10.1)	8 (10.7)	7 (9.5)	0.810
Diastolic dysfunction (grade ≥ II)	26 (17.4)	15 (20.0)	11 (14.9)	0.410
Pericardial effusion	4 (2.7)	3 (4.0)	1 (1.4)	0.360
Clinical outcomes
In-hospital mortality	59 (39.6)	45 (60.0)	14 (18.9)	< 0.001
Invasive mechanical ventilation	62 (41.6)	62 (82.7)	0 (0.0)	< 0.001
Acute kidney injury	45 (30.2)	37 (49.3)	8 (10.8)	< 0.001
Length of hospital stay, (days)	13 (6-23)	18 (11-26)	6 (4-11)	< 0.001

ICU: Intensive care unit; TAPSE: Tricuspid annular plane systolic excursion; PASP: Pulmonary artery systolic pressure.

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Table 3 Laboratory, echocardiographic and prognostic parameters in confirmed coronavirus disease 2019 patients (survivors vs non-survivors), n (%)/median (25^th-75^th percentiles)

Parameter	Survivors (n = 90)	Non-survivors (n = 59)	P value
Biomarkers
Lymphocytes (× 10³/μL)	980 (629-1270)	700 (550-910)	0.003
Leukocytes (cells/μL)	9125 (7155-14037)	11805 (9238-16473)	0.001
Neutrophils (cells/μL)	7460 (5426-11965)	9945 (7883-13869)	< 0.001
Hemoglobin (g/dL)	15.0 (11-17)	14.0 (13-15)	0.026
Platelets (×10³/μL)	291 (224-381)	234 (174-331)	0.003
D-dimer (ng/mL)	2,023 (750-3450)	2,761 (879-6900)	0.155
LDH (U/L)	454 (307-610)	506 (379-736)	0.018
C-reactive protein (mg/L)	95 (43-146)	148 (84-196)	0.006
Quantitative echo parameters
E/e′ ratio	10 (10-12)	10 (9-12.8)	0.334
PASP (mmHg)	42.5 (39.5-51.8)	48 (44-51)	0.087
LVEF (%)	60 (55.5-65)	60 (55-65)	0.959
TAPSE (mm)	22 (20-23)	23 (19.8-25)	0.590
Qualitative findings
Prone position during imaging	3 (3.3)	8 (13.6)	0.026
RV dilatation/overload	17 (18.9)	22 (37.3)	0.008
Regional wall-motion abnormality	9 (10.0)	6 (10.)	0.062
Diastolic dysfunction (any)	43 (47.8)	43 (72.9)	0.197

LDH: Lactate dehydrogenase; PASP: Pulmonary artery systolic pressure; TAPSE: Tricuspid annular plane systolic excursion; LVEF: Left ventricular ejection fraction; RV: Right ventricular.

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Table 4 Echocardiographic indications, appropriateness criteria, and clinical impact in confirmed coronavirus disease 2019 patients (n = 149)

Parameter	n (%)
Echocardiographic Indications (institutional algorithm)
Suspicion of heart failure	127 (85.2)
Elevated biomarkers with hemodynamic instability	38 (25.5)
Hemodynamic instability refractory to fluids/vasopressors	23 (15.4)
Myocardial infarction (universal definition)	19 (12.8)
Tachyarrhythmias (sinus or ventricular)	12 (8.1)
Cardiomegaly on imaging	9 (6.0)
No urgent indication	6 (4.0)
ASE 2020 clinical priority
High priority-change in cardiovascular symptoms	144 (96.6)
High priority-pre-therapy evaluation	3 (2.0)
Intermediate/low priority	2 (1.4)
ACCF 2011 appropriateness criteria
Appropriate	118 (79.2)
Inappropriate	27 (18.1)
Uncertain	4 (2.7)
Clinical impact of echocardiographic findings
Overall change in clinical management (impact)	120 (80.5)
Specific changes (within impact group)
Non-cardiac etiology identified	66 (55.0)
Cardiac primary etiology documented	47 (39.1)
Change in pharmacologic therapy	33 (27.5)
Request for additional diagnostic tests	21 (17.5)
Adjustment of vasopressors or inotropic agents	14 (11.6)
Consultation to other specialties	7 (5.8)
Adjustment in mechanical ventilation	4 (3.3)
No change in clinical management	29 (19.5)
Integration into clinical decision-making
Findings explicitly considered	124 (83.2)
Findings not considered in medical records	25 (16.8)

ACCF: American College of Cardiology Foundation; ASE: American Society of Echocardiography.

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Citation: Méndez-Toro A, Rojas-Ruiz IT, Silva-DiazGranados LE, Ruano-Cadena A, Paz-Meneses MA, Novoa-Alvarez RA. Prognostic impact of right ventricular dilatation and echocardiography use criteria in hospitalized COVID-19 patients. World J Methodol 2026; 16(3): 117845
URL: https://www.wjgnet.com/2222-0682/full/v16/i3/117845.htm
DOI: https://dx.doi.org/10.5662/wjm.v16.i3.117845

Méndez-Toro A, Rojas-Ruiz IT, Silva-DiazGranados LE, Ruano-Cadena A, Paz-Meneses MA, Novoa-Alvarez RA. Prognostic impact of right ventricular dilatation and echocardiography use criteria in hospitalized COVID-19 patients. World J Methodol 2026; 16(3): 117845 [DOI: 10.5662/wjm.v16.i3.117845]

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