Increased RV:LV Ratio on Chest CT-angiogram in COVID-19 is a Marker of Adverse Outcomes

Background: Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease. Results: We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 1 00) , and two control groups: normal subjects (n= 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 +/- 0.10, versus 0.95 +/- 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 +/- 9.0 vs. 32.7 +/- 6.6), yet the RV:LV ratio was higher (1.06 +/- 0.14 vs. 0.89 +/- 0.07). In ROC analysis, RV:LV ratio had an AUC= 0.707 with an optimal cutoff of RV:LV >= 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV >= 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1. Conclusions: In COVID-19 patients, RV:LV ratio >= 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.