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

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.

Early echocardiographic findings in patients hospitalized for COVID-19 pneumonia: a prospective, single center study

“…The detection of a higher sPAP in our more severely affected patients could be part of this picture, in particular reflecting an early pulmonary vascular perturbation, not unexpected in a condition of overt lung involvement. Of notice, sPAP elevation after 2 months from discharge was shown in up to 8% of patients with moderate COVID disease [20].…”

The Evolving Phenotypes of Cardiovascular Disease during COVID-19 Pandemic

“…Signs of PH were only present in a minority of patients [65]. In COVID-19 infection, PH and RV failure are common complications [66], being reported after the recovery even in moderate cases. PH can occur after a COVID-19 viral infection [67].…”

Endothelial metabolism in pulmonary vascular homeostasis and acute respiratory distress syndrome

“…Histological assessment of deceased patients with COVID-19 revealed thickening of the pulmonary vascular walls, a feature commonly seen in pulmonary arterial hypertension (PAH) ( 175 ). Another study evaluated the presence of PH and right ventricular dysfunction in young patients recovering from moderate COVID-19 infections 2 mo after hospital discharge ( 176 ). Each patient was under the age of 55 with no history of cardiovascular disease ( 176 ).…”

“…Another study evaluated the presence of PH and right ventricular dysfunction in young patients recovering from moderate COVID-19 infections 2 mo after hospital discharge ( 176 ). Each patient was under the age of 55 with no history of cardiovascular disease ( 176 ). In this report, PH was prevalent in 7.7% and right ventricular dysfunction was present in 10.3% of patients ( 176 ).…”

“…Each patient was under the age of 55 with no history of cardiovascular disease ( 176 ). In this report, PH was prevalent in 7.7% and right ventricular dysfunction was present in 10.3% of patients ( 176 ). Together, these studies suggest patients with COVID-19 are at risk for developing PH during the acute infection and as a long-term complication.…”