Aim. To determine the predictive role of estimated pulmonary artery systolic pressure (ePASP) in COVID-19 patients.Material and methods. A retrospective study of inpatients with documented COVID-19 infection was carried out. Maximal follow-up period was 63 days. The study included 108 patients (men, 62; women, 46; mean age, 62,9±15,5 years). At admission, mean NEWS score was 6,0, blood oxygen saturation — 92%. Echocardiography was performed according to standard protocol using Vivid E9 ultrasound system (GE Healthcare). Quantitative measurements were performed according to the current ASE and EACVI guidelines. Statistical analysis was performed using the IBM SPSS Statistics v.26 software (developed by IBM Corporation).Results. Using the CHAID technique, a classification tree was developed and the strongest predictor of an unfavorable outcome was determined (ePASP). Threshold ePASP values, associated with an increased mortality risk were established (42 mm Hg and 50 mm Hg). Three groups of patients were selected based on the main predictor (<41,0 mm Hg, 42-49 mm Hg and >50 mm Hg). The increased mortality risk was noted in groups 2 and 3 compared to group 1 of patients and amounted to 31,8% and 70% versus 3,9%, respectively. There was also a correlation between the severity of CT lung parenchymal lesions according to computed tomography and the study groups of patients (36% [30-49%] — group 1, 50% [36-76%] — group 2, and 84% [56-92%] — group 3, p=0,001). In groups 2 and 3, the following complications were significantly more frequent: acute respiratory distress syndrome, acute heart failure, multiple organ system failure, venous thrombosis, disseminated intravascular coagulation. In group 3, acute renal failure and systemic inflammatory response syndrome developed significantly more often than in group 1.Conclusion. A comprehensive echocardiography has proven its availability and safety in assessing the condition of COVID-19 patients, allowing to obtain relevant information on pulmonary hemodynamics. Transthoracic echocardiography reduced the risk of complications from invasive diagnostic methods and allowed to abandon the use of the Swan-Ganz pulmonary artery catheter in the studied group of patients. As a result, a relationship was noted between the increase of ePASP and the severity of clinical performance and lung tissue damage according to computed tomography, changes in laboratory blood tests, the severity of the comorbid profile, an increase in respiratory support need.

Aim To analyze survival of patients with COVID-19 based on echocardiographic (EchoCG) criteria for evaluation of the right ventricular (RV) systolic function.Material and methods Data of patients were retrospectively evaluated at the Center for Medical Care of Patients with Coronavirus Infection. Among 142 primarily evaluated patients with documented COVID-19, 110 patients (men/women, 63/47; mean age, 62.3 ± 15.3 years) met inclusion/exclusion criteria. More than 30 EchoCG parameters were analyzed, and baseline data (comorbidities, oxygen saturation, laboratory data, complications, outcomes, etc.) were evaluated. ROC-analysis was used for evaluating the diagnostic significance of different EchoCG parameters for prediction of a specific outcome and its probability. Dependence of the overall survival of patients on different EchoCG parameters was analyzed with the Cox proportional hazards model. For assessing the predictive value of EchoCG parameters for patient stratification by risk of an adverse outcome, a predictive model was developed using the CHAID method.Results The in-hospital death rate of patients included into the study was 15.5 %, and the death rate for this period of in-hospital observation was 12 %. Based on the single-factor analysis of EchoCG parameters, a multifactor model was developed using the method of Cox regression. The model included two predictors for an unfavorable outcome, estimated pulmonary artery systolic pressure (EPASP) and maximal indexed right atrial volume (RAi), and a preventive factor, right ventricular global longitudinal strain (LS RV). Base risks for fatal outcome were determined with an account of the follow-up time. According to the obtained values, an increase in EPASP by 1 mm Hg was associated with increases in the risk of fatal outcome by 8.6 % and in the RA(i) volume by 1 ml/5.8 %. LS RV demonstrated an inverse correlation; a 1% increase in LS RV was associated with a 13.4% decrease in the risk for an unfavorable outcome. According to the ROC analysis, the most significant determinants of the outcome were the tricuspid annular plane systolic excursion (TAPSE) (AUC, 0.84 ± 0.06; cut-off, 18 mm) and EPASP (AUC, 0.86 ± 0.05; cut-off, 42 mm Hg). Evaluating the effects of different EchoCG predictors, that characterized the condition of the right heart, provided a classification tree. Six final decisions were determined in the model, two of which were assigned to the category of reduced risk for fatal outcome and four were assigned to the category of increased risk. Sensitivity of the classification tree model was 94.1 % and specificity was 89.2 %. Overall diagnostic significance was 90.0±2.9 %.Conclusion The presented models for statistical treatment of EchoCG parameters reflect the requirement for a comprehensive analysis of EchoCG parameters based on a combination of standard methods for EchoCG evaluation and current technologies of noninvasive visualization. According to the study results, the new EchoCG marker, LS RV, allows identifying the signs of right ventricular dysfunction (particularly in combination with pulmonary hemodynamic indexes), may enhance the early risk stratification in patients with COVID-19, and help making clinical decisions for patients with different acute cardiorespiratory diseases.

Objective. To assess efficacy and safety of methylprednisolone pulse therapy in patients with COVID-19. Materials and Methods. A retrospective analysis of 57 patients with moderate and severe novel coronavirus infection (COVID-19) receiving methylprednisolone pulse therapy (500 mg/day IV for 2–3 consecutive days) was performed. Pre- and post-therapy examination of the patients included clinical (severity and duration of fever, gas exchange parameters), imaging (computed tomography) and laboratory tests (including C-reactive protein, procalcitonin, D-dimer). Results. Methylprednisolone pulse therapy resulted in improved gas exchange (the mean duration of SpO2 recovery was 3.9 ± 0.25 days), body temperature normalization (the mean time to defervescence was 2.1 ± 0.2 days), significant decrease in inflammatory marker levels (CRP, D-dimer). No patients required an enhancement of respiratory support (transfer to ICU). Methylprednisolone pulse therapy was well-tolerated and did not cause bacterial complications. Conclusions. Methylprednisolone pulse therapy in patients with COVID-19 was shown to decrease activity of systemic inflammatory response, severity of coagulation disorders and contribute to recovery of gas exchange lung function. Given the high efficacy and low cost of methylprednisolone pulse therapy, it could be one of the promising approaches to the management of patients with moderate and severe COVID-19. Further studies are needed to determine prognostic criteria of progression and optimal time for initiation of corticosteroid therapy.

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