Management of COVID-19 in Patients with Pulmonary Arterial Hypertension

Farmakis, Ioannis; Giannakoulas, George

doi:10.1016/j.hfc.2022.07.003

Cited by 6 publications

(6 citation statements)

References 39 publications

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“… 209 , 210 Several theories were advanced to explain these early observations, including endothelial-protective effects of targeted PAH therapies, limited viral entry consequent to lower angiotensin-converting enzyme-2 (ACE-2) expression in PAH, and reduced responsiveness to changes in lung perfusion in PAH. 211 However, as experience with COVID-19 in patients with PAH accumulated, it was apparent that outcomes were less favorable than initially thought. In late 2020 a report emerged from a survey of 47 PH centers around the world collectively reporting 70 cases of COVID-19 infection in PAH and CTEPH patients from April 17, 2020 through May 10, 2020.…”

Section: The Challenge Of Covid Infection In Patients With Pulmonary ...mentioning

confidence: 99%

“…While COVID-19 infection should be managed according to contemporary treatment guidelines, potential interactions between COVID-19 and PAH drug treatments should be taken into consideration. 211 High risk patients who can be managed on an outpatient basis, yet are susceptible to unfavorable outcomes with infection, may benefit from treatment with newer antivirals, such as molnupiravir and nirmatrelvir-ritonavir. There are no significant interactions reported between molnupiravir and currently available PAH therapies.…”

Section: The Challenge Of Covid Infection In Patients With Pulmonary ...mentioning

confidence: 99%

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The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges

Swisher¹,

Weaver²

2023

VHRM

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Pulmonary hypertension may develop as a disease process specific to pulmonary arteries with no identifiable cause or may occur in relation to other cardiopulmonary and systemic illnesses. The World Health Organization (WHO) classifies pulmonary hypertensive diseases on the basis of primary mechanisms causing increased pulmonary vascular resistance. Effective management of pulmonary hypertension begins with accurately diagnosing and classifying the disease in order to determine appropriate treatment. Pulmonary arterial hypertension (PAH) is a particularly challenging form of pulmonary hypertension as it involves a progressive, hyperproliferative arterial process that leads to right heart failure and death if untreated. Over the last two decades, our understanding of the pathobiology and genetics behind PAH has evolved and led to the development of several targeted disease modifiers that ameliorate hemodynamics and quality of life. Effective risk management strategies and more aggressive treatment protocols have also allowed better outcomes for patients with PAH. For those patients who experience progressive PAH with medical therapy, lung transplantation remains a life-saving option. More recent work has been directed at developing effective treatment strategies for other forms of pulmonary hypertension, such as chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary hypertension due to other lung or heart diseases. The discovery of new disease pathways and modifiers affecting the pulmonary circulation is an ongoing area of intense investigation.

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Section: The Challenge Of Covid Infection In Patients With Pulmonary ...mentioning

confidence: 99%

Section: The Challenge Of Covid Infection In Patients With Pulmonary ...mentioning

confidence: 99%

The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges

Swisher¹,

Weaver²

2023

VHRM

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“…Because PAH patients’ lung function has been impaired, their pulmonary blood vessels have become narrowed, and if they are infected with the SARS-CoV-2 virus, it may lead to a more serious condition. It is generally accepted that the COVID-19 prognosis for patients with PAH is determined by a combination of underlying PAH disease characteristics and risk stratification and other factors such as age, functional status, and comorbidities [ 65 , 76 ].…”

Section: Role Of Sars-cov-2mentioning

confidence: 99%

Human Endogenous Retrovirus, SARS-CoV-2, and HIV Promote PAH via Inflammation and Growth Stimulation

Wang

Gomes

et al. 2023

IJMS

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Pulmonary arterial hypertension (PAH) is a pulmonary vascular disease characterized by the progressive elevation of pulmonary arterial pressures. It is becoming increasingly apparent that inflammation contributes to the pathogenesis and progression of PAH. Several viruses are known to cause PAH, such as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), human endogenous retrovirus K(HERV-K), and human immunodeficiency virus (HIV), in part due to acute and chronic inflammation. In this review, we discuss the connections between HERV-K, HIV, SARS-CoV-2, and PAH, to stimulate research regarding new therapeutic options and provide new targets for the treatment of the disease.

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“…Moreover, accumulating evidence suggests that COVID-19 aggravates clinical conditions and increases mortality in patients with PH. [14][15][16] Unfortunately, few published data are available on the role of vaccination in this population, which makes it difficult for physicians or patients to decide whether they should recommend or receive the vaccination. To address this issue, we conducted a prospective cohort study using the data from National Rare Diseases Registry System of China to assess PHrelated major adverse events of the approved vaccines.…”

Section: Introductionmentioning

confidence: 99%

Vaccination against coronavirus disease 2019 in patients with pulmonary hypertension: A national prospective cohort study

et al. 2023

Chinese Medical Journal

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Background: Coronavirus disease 2019 (COVID-19) has potential risks for both clinically worsening pulmonary hypertension (PH) and increasing mortality. However, the data regarding the protective role of vaccination in this population are still lacking. This study aimed to assess the safety of approved vaccination for patients with PH. Methods: In this national prospective cohort study, patients diagnosed with PH (World Health Organization [WHO] groups 1 and 4) were enrolled from October 2021 to April 2022. The primary outcome was the composite of PH-related major adverse events. We used an inverse probability weighting (IPW) approach to control for possible confounding factors in the baseline characteristics of patients. Results: In total, 706 patients with PH participated in this study (mean age, 40.3 years; mean duration after diagnosis of PH, 8.2 years). All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China. Among them, 278 patients did not receive vaccination, whereas 428 patients completed the vaccination series. None of the participants were infected with COVID-19 during our study period. Overall, 398 patients received inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, whereas 30 received recombinant protein subunit vaccine. After adjusting for baseline covariates using the IPW approach, the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase (27/428 [6.3%] vs. 24/278 [8.6%], odds ratio = 0.72, P = 0.302). Approximately half of the vaccinated patients reported at least one post-vaccination side effects, most of which were mild, including pain at the injection site (159/428, 37.1%), fever (11/428, 2.6%), and fatigue (26/428, 6.1%). Conclusions: COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH, although there were some tolerable side effects. A large-scale randomized controlled trial is warranted to confirm this finding. The final approval of the COVID-19 vaccination for patients with PH as a public health strategy is promising.

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Management of COVID-19 in Patients with Pulmonary Arterial Hypertension

Cited by 6 publications

References 39 publications

The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges

The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges

Human Endogenous Retrovirus, SARS-CoV-2, and HIV Promote PAH via Inflammation and Growth Stimulation

Vaccination against coronavirus disease 2019 in patients with pulmonary hypertension: A national prospective cohort study

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