Evidence of Pulmonary Hypertension after SARS-CoV-2 Infection in Subjects without Previous Significant Cardiovascular Pathology.

Cristina Tudoran,Alexandru Silvius Pescariu,Gheorghe Nicusor Pop,Voichita Elena Lazureanu,Alexandra Enache,Talida Georgiana Cut,Adelina Raluca Marinescu,Mariana Tudoran

doi:10.3390/jcm10020199

Abstract

Background: Coronavirus (Covid-19) infection represents a serious medical condition, often associated with cardiovascular complications, pulmonary hypertension (PH), and right ventricle dysfunction (RVD). The aim of this study is to show, by means of transthoracic echocardiography (TTE), the presence of an increased estimated systolic pressure in the pulmonary artery (esPAP) and altered right ventricular global longitudinal strain (RV-GLS) in patients without history of PH. Methods: In a group of 91 patients, aged under 55 years, hospitalized for a moderate Covid-19 infection, a thorough cardiologic and TTE examination were performed two months after discharge. Their initial thorax computer-tomography (TCT) images and laboratory data were accessed from the electronic data base of the hospital. Results: We observed an increased prevalence of PH (7.69%) and RVD (10.28%), significantly correlated with the initial levels of the TCT score and inflammatory factors (p ˂ 0.001), but borderline changes were observed in more patients. Multivariate regression analysis showed that these factors and RV-GLS explain 89.5% of elevated esPAP. Conclusions: In COVID-19 infection, PH and RVD are common complications, being encountered after the recovery even in moderate cases. It appears to be a connection between their severity and the extent of the initial pulmonary injury and of the inflammatory response.

Highlights

Coronavirus pandemic infection (COVID-19), determined by the coronavirus 2 (SARSCoV-2), represents a serious medical condition, characterized mainly by severe pneumonia, which is often associated with acute respiratory distress syndrome (ARDS), respiratory failure (RF), and multiple organ dysfunction/failure [1,2]
In order to increase the accuracy of our results, a semi-quantitative thorax computer-tomography (TCT) re-assessment of pulmonary lesions, according to the severity scoring proposed by Pan et al [13], was performed at the beginning of the study
We considered that estimated systolic PAP (esPAP) values of ≥35 mm Hg at rest, indicates pulmonary hypertension (PH) [3,10] with the severity ranging from mild (35–44 mm Hg), to moderate (45–60 mm Hg) and severe (>60 mm Hg) [14,15]

Summary

Introduction

Coronavirus pandemic infection (COVID-19), determined by the coronavirus 2 (SARSCoV-2), represents a serious medical condition, characterized mainly by severe pneumonia, which is often associated with acute respiratory distress syndrome (ARDS), respiratory failure (RF), and multiple organ dysfunction/failure [1,2]. As a consequence of lung parenchymal damage and of altered pulmonary circulation, pulmonary hypertension (PH) may develop, leading to right ventricular (RV) involvement and right 4.0/). Heart failure (RHF) [5] The pathophysiology of this type of PH is complex and multifactorial and mechanisms such as oxidative stress, mitochondrial dysfunction, and DNA damage, inflammation, hypoxia, associated with endothelial dysfunction, and pulmonary micro-embolism have been considered potential factors for the alterations of pulmonary circulation [6]. Coronavirus (Covid-19) infection represents a serious medical condition, often associated with cardiovascular complications, pulmonary hypertension (PH), and right ventricle dysfunction (RVD). The aim of this study is to show, by means of transthoracic echocardiography (TTE), the presence of an increased estimated systolic pressure in the pulmonary artery (esPAP)

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