---
title: "Right ventricular dilatation on echocardiography predicts mortality in hospitalized COVID-19 patie"
id: "pubmed-42626049"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42626049"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42626049/"
doi: "10.5662/wjm.v16.i3.117845"
published_at: "2026-09-20T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Right ventricular dilatation on echocardiography predicts mortality in hospitalized COVID-19 patie
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42626049
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42626049/)
- **DOI:** [10.5662/wjm.v16.i3.117845](https://doi.org/10.5662%2Fwjm.v16.i3.117845)
- **Published At:** 2026-09-20T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study assessed prognostic value of transthoracic echocardiography (TTE) and adherence to Appropriate Use Criteria (AUC) in hospitalized patients with confirmed COVID-19. - This was a retrospective cohort of 149 patients; median age 66 years (IQR 56–73) and median hospital stay 13 days (IQR 6–23). - Overall mortality was 39.6%; intensive care unit mortality was 60%. - Elevated laboratory markers (leukocytes, neutrophils, lactate dehydrogenase, C-reactive protein) were associated with higher mortality. - The only echocardiographic finding that independently predicted mortality was **right ventricular (RV) dilatation and/or strain** (P = 0.008). - Inter-observer agreement for classifying TTE indications by AUC (based on ACCF 2011 and ASE 2020 guidelines) was high (κ ≥ 0.798). - TTE findings led to a change in clinical management in 79.7% of cases, indicating substantial clinical impact. - Authors conclude that **RV pathology** is a measurable, strong prognostic indicator in severe COVID-19 and that while AUC are reliable, they may have limitations when applied to the acute prognostic challenges of COVID-19. - Conflict of interest: authors declared no conflicts. Specific methodology details beyond the abstract (e.g., exact selection criteria, multivariable models, or follow-up duration) were not reported in the PubMed abstract.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Cardiology, Hospital Universitario Nacional de Colombia/Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia. arnold.mendez@hun.edu.co. * 2 Faculty of Nursing, Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia. * 3 Department of Cardiology, Sigandini, Bogota 110110, Bogotá, Colombia. * 4 Internal Medicine, Universidad Nacional de Colombia, Bogota 110110, Bogotá, Colombia. * 5 Department of Cardiology, Clinica Colombia, Bogota 110110, Bogotá, Colombia. * 6 Research and Innovation Center, Navarra University Foundation, Neiva 410001, Huila, Colombia. * PMID: **42626049** * PMCID: **PMC13491187** (available on 2026-09-20) * DOI: [ 10.5662/wjm.v16.i3.117845 ](https://doi.org/10.5662/wjm.v16.i3.117845) Item in Clipboard # Prognostic impact of right ventricular dilatation and echocardiography use criteria in hospitalized COVID-19 patients Arnold Méndez-Toro et al. World J Methodol. 2026. Show details Display options Display options Format Abstract PubMed PMID World J Methodol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22World+J+Methodol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22World+J+Methodol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42626049/) . 2026 Sep 20;16(3):117845. doi: 10.5662/wjm.v16.i3.117845. ### Authors [Arnold Méndez-Toro](https://pubmed.ncbi.nlm.nih.gov/?term=M%C3%A9ndez-Toro+A&cauthor_id=42626049)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42626049/#short-view-affiliation-1 "Department of Cardiology, Hospital Universitario Nacional de Colombia/Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia. arnold.mendez@hun.edu.co."), [Ingrid Tatiana Rojas-Ruiz](https://pubmed.ncbi.nlm.nih.gov/?term=Rojas-Ruiz+IT&cauthor_id=42626049)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42626049/#short-view-affiliation-2 "Faculty of Nursing, Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia."), [Luis Eduardo Silva-DiazGranados](https://pubmed.ncbi.nlm.nih.gov/?term=Silva-DiazGranados+LE&cauthor_id=42626049)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42626049/#short-view-affiliation-3 "Department of Cardiology, Sigandini, Bogota 110110, Bogotá, Colombia."), [Andrés Ruano-Cadena](https://pubmed.ncbi.nlm.nih.gov/?term=Ruano-Cadena+A&cauthor_id=42626049)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42626049/#short-view-affiliation-4 "Internal Medicine, Universidad Nacional de Colombia, Bogota 110110, Bogotá, Colombia."), [Manuel Agustín Paz-Meneses](https://pubmed.ncbi.nlm.nih.gov/?term=Paz-Meneses+MA&cauthor_id=42626049)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42626049/#short-view-affiliation-5 "Department of Cardiology, Clinica Colombia, Bogota 110110, Bogotá, Colombia."), [Ricardo Andrés Novoa-Alvarez](https://pubmed.ncbi.nlm.nih.gov/?term=Novoa-Alvarez+RA&cauthor_id=42626049)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42626049/#short-view-affiliation-6 "Research and Innovation Center, Navarra University Foundation, Neiva 410001, Huila, Colombia.") ### Affiliations * 1 Department of Cardiology, Hospital Universitario Nacional de Colombia/Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia. arnold.mendez@hun.edu.co. * 2 Faculty of Nursing, Universidad Nacional de Colombia, Bogota 111321, Bogotá, Colombia. * 3 Department of Cardiology, Sigandini, Bogota 110110, Bogotá, Colombia. * 4 Internal Medicine, Universidad Nacional de Colombia, Bogota 110110, Bogotá, Colombia. * 5 Department of Cardiology, Clinica Colombia, Bogota 110110, Bogotá, Colombia. * 6 Research and Innovation Center, Navarra University Foundation, Neiva 410001, Huila, Colombia. * PMID: **42626049** * PMCID: **PMC13491187** (available on 2026-09-20) * DOI: [ 10.5662/wjm.v16.i3.117845 ](https://doi.org/10.5662/wjm.v16.i3.117845) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## 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:** Appropriate use criteria; COVID-19; Echocardiography; Prognosis; Right ventricular strain; SARS-CoV-2. ©Author(s) 2026. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 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. ## Similar articles * [ Prognostic value of right ventricular dilatation in patients with COVID-19: a multicentre study. ](https://pubmed.ncbi.nlm.nih.gov/34008835/) Soulat-Dufour L, Fauvel C, Weizman O, Barbe T, Pezel T, Mika D, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Duceau B, Sutter W, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Trimaille A, Bonnet G, Canu M, Coisne A, Cohen A.Soulat-Dufour L, et al.Eur Heart J Cardiovasc Imaging. 2022 Mar 22;23(4):569-577. doi: 10.1093/ehjci/jeab067.Eur Heart J Cardiovasc Imaging. 2022.PMID: 34008835Free PMC article. * [ Comparison of clinical and echocardiographic features of first and second waves of COVID-19 at a large, tertiary medical center serving a predominantly African American patient population. ](https://pubmed.ncbi.nlm.nih.gov/34460023/) Karagodin I, Singulane CC, Besser SA, Singh A, Addetia K, DeCara JM, Patel AR, Ward RP, Tung R, Lang RM.Karagodin I, et al.Int J Cardiovasc Imaging. 2021 Nov;37(11):3181-3190. doi: 10.1007/s10554-021-02393-y. Epub 2021 Aug 30.Int J Cardiovasc Imaging. 2021.PMID: 34460023Free PMC article. * [ Safety and Efficacy of Imatinib for Hospitalized Adults with COVID-19: A structured summary of a study protocol for a randomised controlled trial. ](https://pubmed.ncbi.nlm.nih.gov/33115543/) Emadi A, Chua JV, Talwani R, Bentzen SM, Baddley J.Emadi A, et al.Trials. 2020 Oct 28;21(1):897. doi: 10.1186/s13063-020-04819-9.Trials. 2020.PMID: 33115543Free PMC article. * [ Accuracy of routine laboratory tests to predict mortality and deterioration to severe or critical COVID-19 in people with SARS-CoV-2. ](https://pubmed.ncbi.nlm.nih.gov/39105481/) De Rop L, Bos DA, Stegeman I, Holtman G, Ochodo EA, Spijker R, Otieno JA, Alkhlaileh F, Deeks JJ, Dinnes J, Van den Bruel A, McInnes MD, Leeflang MM; Cochrane COVID-19 Diagnostic Test Accuracy Group; Verbakel JY.De Rop L, et al.Cochrane Database Syst Rev. 2024 Aug 6;8(8):CD015050. doi: 10.1002/14651858.CD015050.pub2.Cochrane Database Syst Rev. 2024.PMID: 39105481Free PMC article. * [ Echocardiographic Parameters of Right Ventricular Size and Function Associated With Right Heart Failure After Durable Left Ventricular Assist Device Implantation-A Systematic Review and Meta-Analysis. ](https://pubmed.ncbi.nlm.nih.gov/40033957/) Chai JCK, Chew JL, Amarasekera A, Soliman Aboumarie H, Tan TC.Chai JCK, et al.Echocardiography. 2025 Mar;42(3):e70119. doi: 10.1111/echo.70119.Echocardiography. 2025.PMID: 40033957Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42626049) ## References 1. 1. Ashton RE, Philips BE, Faghy M. The acute and chronic implications of the COVID-19 virus on the cardiovascular system in adults: A systematic review. Prog Cardiovasc Dis. 2023;76:31–37. - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC9854143/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/36690284/) 2. 1. Chotalia M, Ali M, Alderman JE, Kalla M, Parekh D, Bangash MN, Patel JM. Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome. Crit Care Med. 2021;49:1757–1768. - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC8439642/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/34224453/) 3. 1. Sewanan LR, Clerkin KJ, Tucker NR, Tsai EJ. How Does COVID-19 Affect the Heart? Curr Cardiol Rep. 2023;25:171–184. - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC9999058/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/36897483/) 4. 1. Liao M, Pan J, Liao T, Liu X, Wang L. Transthoracic echocardiographic assessment of ventricular function in functional single ventricle: a comprehensive review. Cardiovasc Ultrasound. 2025;23:9. - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC11908059/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40087765/) 5. 1. Gomez JMD, Zimmerman AC, du Fay de Lavallaz J, Wagner J, Tung L, Bouroukas A, Nguyen TTP, Canzolino J, Goldberg A, Santos Volgman A, Suboc T, Rao AK. Echocardiographic predictors of mortality and morbidity in COVID-19 disease using focused cardiovascular ultrasound. Int J Cardiol Heart Vasc. 2022;39:100982. - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC8872842/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/35233442/) Show all 30 references ## Related information * [ MedGen ](https://www.ncbi.nlm.nih.gov/medgen?linkname=pubmed_medgen&from_uid=42626049 "Related information in MedGen") ## LinkOut - more resources * ### Full Text Sources * [ Baishideng Publishing Group Inc. ](https://www.wjgnet.com/2222-0682/full/v16/i3/117845.htm) * ### Research Materials * [ NCI CPTC Antibody Characterization Program ](https://antibodies.cancer.gov/detail/CPTC-CRP-1) * ### Miscellaneous * [ NCI CPTAC Assay Portal ](https://assays.cancer.gov/CPTAC-438) **Full text links** [x] [![Baishideng Publishing Group Inc. full text link](https://cdn.ncbi.nlm.nih.gov/corehtml/query/egifs/https:--www.wjgnet.com-fil
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