Early Cardiovascular Phenotypes in Patients with Acute Respiratory Failure during the Initial Covid-19 Pandemic

Objective: The main objective was to compare the prevalence of left ventricular (LV) and/or right ventricular (RV) dysfunction in patients admitted to the Emergency Department (ED) with an acute respiratory failure (ARF) related to Covid-19 or not. Methods: We prospectively enrolled consecutive adult patients (24/7) during one month in the Covid-19 unit of our ED who presented with ARF. In each patient, a RTPCR test, chest CT scan, and level 2 echocardiography were systematically performed before any therapeutic intervention. Distinct cardiovascular phenotypes were distinguished: LVor RV failure, hypovolemia +/- LV hyperkinesia, and normal hemodynamic profile. Results: Of the 517 patients admitted to the Covid-19 unit during the study period, 78 presented with ARF (15%), and echocardiography was performed in 62 of them (age: 73 +/- 14 years; SpO(2): 90 +/- 4%; lactate: 2.1 +/- 1.3 mmol/l). Twenty-two patients (35%) were diagnosed with Covid-19 pneumonia. LV failure was more frequently observed in the control group (15 [38%] vs. 2 [9%]; P = 0.016), irrespective of LVejection fraction, as well as RV failure (12 [30%] vs. 1 [5%]; P = 0.018). In contrast, Covid-19 patients exhibited more frequently a normal hemodynamic profile or hypovolemia associated or not with vasoplegia (20 [91%] vs. 21 [53%]; P = 0.002). Hospital mortality reached 18% (N = 11). All patients with Covid-19 pneumonia and early LV and/or RV failure died during their hospitalization. Conclusions: Non-Covid-19 ARF patients mainly exhibited LV/RV dysfunction, whereas patients with Covid-19 had a normal or hypovolemic cardiovascular phenotype.