Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race

Research output: Contribution to journalArticlepeer-review


  • Hani M Mahmoud-Elsayed
  • Jonathan Senior
  • Uzma Gul
  • Ayisha M Khan-Kheil
  • Sebastian Horne
  • Amitava Banerjee
  • William M Bradlow
  • Robert Huggett
  • Sandeep S Hothi
  • Muhammad Shahid
  • Richard P Steeds

Colleges, School and Institutes

External organisations

  • Russells Hall Hospital
  • University College London
  • New Cross Hospital
  • Queen Elizabeth Hospital


Background: Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia. Methods: This was a multicentre, retrospective, observational study including 164 adults (aged 61 ± 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (interquartile range 2-5) from admission. The primary outcome was all-cause mortality. Results: After a median follow-up of 31 days (interquartile range 14-42 days), 66 (40%) patients had died. The right ventricle was dilated in 62 (38%) patients, and 58 (35%) patients had right ventricular (RV) systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation, and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = −0.18, P = 0.025) and high-sensitivity cardiac Troponin (ρ = −0.30, P < 0.0001). Reduced RV systolic function (hazard ratio 1.80; 95% confidence interval, 1.05-3.09; P = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers, or mortality. Conclusions: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is, however, no racial variation in the early findings on echocardiography, biomarkers, or mortality.

Bibliographic note

Funding Information: This study was supported by a British Heart Foundation Accelerator Award, UK ( BHF AA/18/2/34218 ). Publisher Copyright: © 2020 Canadian Cardiovascular Society


Original languageEnglish
Pages (from-to)91-100
Number of pages10
JournalCJC open
Issue number1
Early online date20 Sep 2020
Publication statusPublished - Jan 2021