Pulmonary arterial hypertension and right ventricular systolic dysfunction in COVID-19 survivors

Rossi, Rosario; Coppi, Francesca; Monopoli, Daniel; Sgura, Fabio; Arrotti, Salvatore; Boriani, Giuseppe

doi:10.5603/cj.a2021.0159

Cited by 17 publications

(11 citation statements)

References 10 publications

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“…Over-activation of RAS with reduction of Ang1-7, ED, and coagulopathy could be the major causes for the development of hypertension in patients with PCS [ 149 ]. Besides, ED and pulmonary thromboembolic disorders may increase the risk of the development of pulmonary hypertension [ 150 ].…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of Post-COVID syndromes: a new perspective

Batiha

Al-Kuraishy

Al-Gareeb

et al. 2022

Virol J

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Most COVID-19 patients recovered with low mortality; however, some patients experienced long-term symptoms described as “long-COVID” or “Post-COVID syndrome” (PCS). Patients may have persisting symptoms for weeks after acute SARS-CoV-2 infection, including dyspnea, fatigue, myalgia, insomnia, cognitive and olfactory disorders. These symptoms may last for months in some patients. PCS may progress in association with the development of mast cell activation syndrome (MCAS), which is a distinct kind of mast cell activation disorder, characterized by hyper-activation of mast cells with inappropriate and excessive release of chemical mediators. COVID-19 survivors, mainly women, and patients with persistent severe fatigue for 10 weeks after recovery with a history of neuropsychiatric disorders are more prone to develop PCS. High D-dimer levels and blood urea nitrogen were observed to be risk factors associated with pulmonary dysfunction in COVID-19 survivors 3 months post-hospital discharge with the development of PCS. PCS has systemic manifestations that resolve with time with no further complications. However, the final outcomes of PCS are chiefly unknown. Persistence of inflammatory reactions, autoimmune mimicry, and reactivation of pathogens together with host microbiome alterations may contribute to the development of PCS. The deregulated release of inflammatory mediators in MCAS produces extraordinary symptoms in patients with PCS. The development of MCAS during the course of SARS-CoV-2 infection is correlated to COVID-19 severity and the development of PCS. Therefore, MCAS is treated by antihistamines, inhibition of synthesis of mediators, inhibition of mediator release, and inhibition of degranulation of mast cells.

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Section: Introductionmentioning

confidence: 99%

Pathophysiology of Post-COVID syndromes: a new perspective

Batiha

Al-Kuraishy

Al-Gareeb

et al. 2022

Virol J

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“…However, over a period of time these changes resolved. 23 It is unclear if we can extrapolate these findings to our study.…”

Section: Resultsmentioning

confidence: 77%

Echocardiographic Assessment of Right Ventricular Function in COVID-19 Recovered Patients at a Tertiary Care Hospital

Balqees

Hussain²,

Yusuf³

et al. 2022

PAFMJ

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Objective: To detect residual RV dysfunction on a right ventricle focused Transthoracic Echocardiography (TTE) in COVID-19 infection survivors with lung involvement. Study Design: Analytical Cross sectional study design. Place and Duration of Study: Combined Military Hospital Abbottabad Pakistan, Feb 2022 to Apr 2022. Methodology: 87 patients who had suffered from and survived COVID-19 infection with definite involvement on CT scans of the chest were studied after discharge. Echocardiography was done to determine the RV anatomical and functional parameters to determine the relationship between extent of lung involvement and transthoracic echocardiographic parameters.Data was entered in Microsoft excel and exported to SPSS v 23 for analysis. Results: The initial sample size was of 87 patients. Due to suboptimal ECHO studies 7 cases were excluded. Males represented 62.5% (n=50) and females 37.5% (n=30). The ages ranged from 27 to 80 years, mean 53.08±12.77 years. Based on the CT severity score severe infections were 61.3 %(n=49) and mild 38.8% (n=31). The CTSS ranged from 6 to 30 with a mean of (17.74±7.13). In our study we found that on TTE, there was a statistically significant difference in 2 of the anatomical parameters; RVOT PLAX (RVOT diameter in Parasternal long axis view) [27.4 vs 28.3; p=0.02], RVOT-Dis (Distal RVOT dia) [22.8 vs 24; p=0.01]. In addition, there was a statistically significant difference in all the functional parameters of RV function TDI S vel (Systolic Tissue Doppler Velocity of the Tricuspid Annulus by Tissue doppler imaging) [7 vs4.9; p<0.0001], RIMPPW (Right Ventricular Index of Myocardial Performance by Pulse wave doppler) [0.46 vs0.38; p<0.0001], RIMP-TDI (Right Ventricular Index of Myocardial Performance by Tissue doppler imaging) [0.57 vs 0.48; p<0.0001]. RV-FAC (RV-Fractional Area Change) was statistically insignificant. [42.8% vs 43.2%; p=0.6]. Conclusion: Our study showed that in patients with definite lung involvement on chest CT scans, functional echocardiographic parameters of Right ventricular function were affected in line with the severity of lung involvement.

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“…Rossi and colleagues performed a right heart catheterization (RHC) and a 6-min walking test (6MWT) in 25 consecutive COVID-19 survivors who presented to their divisional outpatient clinic with signs and symptoms suggestive of “Long COVID” ( Rossi et al, 2022 ). The authors compared these RHC and 6MWT data with those of their 25-counterpart gender- and age-matched asymptomatic COVID-19 survivors.…”

Section: The Global Impact Of Sars-cov-2-associated Pulmonary Hyperte...mentioning

confidence: 99%

“…The authors compared these RHC and 6MWT data with those of their 25-counterpart gender- and age-matched asymptomatic COVID-19 survivors. Interestingly, all patients with “Long COVID” were found to have pulmonary arterial hypertension and severe right ventricular systolic dysfunction ( Rossi et al, 2022 ).…”

Section: The Global Impact Of Sars-cov-2-associated Pulmonary Hyperte...mentioning

confidence: 99%

From acute SARS-CoV-2 infection to pulmonary hypertension

2022

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As the world progressively recovers from the acute stages of the coronavirus disease 2019 (COVID-19) pandemic, we may be facing new challenges regarding the long-term consequences of COVID-19. Accumulating evidence suggests that pulmonary vascular thickening may be specifically associated with COVID-19, implying a potential tropism of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus for the pulmonary vasculature. Genetic alterations that may influence the severity of COVID-19 are similar to genetic drivers of pulmonary arterial hypertension. The pathobiology of the COVID-19-induced pulmonary vasculopathy shares many features (such as medial hypertrophy and smooth muscle cell proliferation) with that of pulmonary arterial hypertension. In addition, the presence of microthrombi in the lung vessels of individuals with COVID-19 during the acute phase, may predispose these subjects to the development of chronic thromboembolic pulmonary hypertension. These similarities raise the intriguing question of whether pulmonary hypertension (PH) may be a long-term sequela of SARS-COV-2 infection. Accumulating evidence indeed support the notion that SARS-COV-2 infection is indeed a risk factor for persistent pulmonary vascular defects and subsequent PH development, and this could become a major public health issue in the future given the large number of individuals infected by SARS-COV-2 worldwide. Long-term studies assessing the risk of developing chronic pulmonary vascular lesions following COVID-19 infection is of great interest for both basic and clinical research and may inform on the best long-term management of survivors.

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Pulmonary arterial hypertension and right ventricular systolic dysfunction in COVID-19 survivors

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Cardiology Journal" are listed in PubMed.

Cited by 17 publications

References 10 publications

Pathophysiology of Post-COVID syndromes: a new perspective

Pathophysiology of Post-COVID syndromes: a new perspective

Echocardiographic Assessment of Right Ventricular Function in COVID-19 Recovered Patients at a Tertiary Care Hospital

From acute SARS-CoV-2 infection to pulmonary hypertension

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