An Update on Pulmonary Hypertension in Coronavirus Disease-19 (COVID-19) Pulmonary Hypertension and COVID -19

Main Article Content

Ajay Mishra
Amos Lal
Kamal Kant Sahu
Anu Anna George
Kevin Martin
Jennifer Sargent

Keywords

COVID 19, Pulmonary Hypertension, Outcome

Abstract

Coronavirus 19 disease (COVID-19) continues to be a pandemic with global implications.  Respiratory system involvement is the most common manifestation in symptomatic patients.  In this literature review, we describe the diagnosis, management, and implications of pulmonary hypertension (PH) among patients with COVID-19.  We defined pulmonary hypertension as increasing mean pulmonary artery pressure (mPAP) of ≥ 25 mm Hg at rest.  In our literature search, we identified 4 articles with details on pulmonary hypertension.  Among these, two reported various echocardiographic details for diagnosing pulmonary hypertension.  In 1 study evidence of pulmonary hypertension was noted in 13.4% of patients.  Patients with severe COVID-19 were reported to have a higher proportion of pulmonary hypertension as compared to mild COVID-19 disease [22% vs 2%].  Elevated pulmonary artery systolic pressure was significant in predicting mortality.  COVID-19 patients with chronic obstructive pulmonary disease, congestive heart failure, myocardial injury, pulmonary embolism, and prior pulmonary hypertension were at a higher risk of worsening pulmonary hypertension.  Multiple mechanisms for developing pulmonary hypertension that have been postulated are i) concomitant worsening myocardial injury, ii) cytokine storm, endothelial injury, hypercoagulability attributing to development of venous thromboembolism, iii) and the presence of thrombotic microangiopathy.  Among patients with severe COVID-19 disease and pulmonary hypertension, complications including acute respiratory distress syndrome, acute myocardial injury, the requirement of intensive care unit admission, the requirement of mechanical ventilation, and mortality are higher.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 8 |

References

1. Sahu KK, Mishra AK, Lal A. Comprehensive update on current outbreak of novel
coronavirus infection (2019-nCoV). Ann Transl Med. 2020;8(6):393.
doi:10.21037/atm.2020.02.92.
2. Mishra AK, Sahu KK, Lal A, Sargent J. Patterns of heart Injury in COVID - 19 and
relation to outcome [published online ahead of print, 2020 Apr 8]. J Med Virol.
2020;10.1002/jmv.25847. doi:10.1002/jmv.25847.
3. Farber HW, Loscalzo J. Pulmonary arterial hypertension. N Engl J Med. 2004; 351:
1655–1665.
4. Augustine DX, Coates-Bradshaw LD, Willis J, et al. Echocardiographic assessment of
pulmonary hypertension: a guideline protocol from the British Society of
Echocardiography. Echo Res Pract. 2018;5(3):G11‐G24. doi:10.1530/ERP-17-0071.
5. Deng Q, Hu B, Zhang Y, et al. Suspected myocardial injury in patients with COVID-19:
Evidence from front-line clinical observation in Wuhan, China [published online ahead of
print, 2020 Apr 8]. Int J Cardiol. 2020;S0167-5273(20)31115-3.
doi:10.1016/j.ijcard.2020.03.087.
6. Buja LM, Wolf DA, Zhao B, et al. The emerging spectrum of cardiopulmonary pathology
of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston,
Texas, and review of autopsy findings from other United States cities [published online
ahead of print, 2020 May 7]. Cardiovasc Pathol. 2020;48:107233.
doi:10.1016/j.carpath.2020.107233.
7. Li Y, Li H, Zhu S, Xie Y, Wang B, He L, et al. Prognostic Value of Right Ventricular
Longitudinal Strain in Patients with COVID-19. JACC Cardiovasc Imaging. 2020 Apr
28;3423.
8. Zamanian RT, Pollack CV Jr, Gentile MA, et al. Outpatient Inhaled Nitric Oxide in a
Patient with Vasoreactive IPAH and COVID-19 Infection [published online ahead of
print, 2020 May 5]. Am J Respir Crit Care Med. 2020;10.1164/rccm.202004-0937LE.
doi:10.1164/rccm.202004-0937LE.
9. Mishra AK, Sahu KK, George AA, Lal A. A review of cardiac manifestations and
predictors of outcome in patients with COVID – 19 [published online ahead of print,
2020 May 3]. Heart Lung. 2020;doi:10.1016/j.hrtlng.2020.04.019.
10. Mishra AK, Lal A, Sahu KK, George AA, Sargent J. Mechanisms of neurological injury
in COVID -19 [published online ahead of print, 2020 May 17]. World Neurosurg.
2020;10.1016/j.wneu.2020.05.089. doi:10.1016/j.wneu.2020.05.089.
11. Sahu KK, Mishra AK, Lal A. COVID-2019: update on epidemiology, disease spread and
management. Monaldi Arch Chest Dis. 2020;90(1):10.4081/monaldi.2020.1292.
Published 2020 Apr 16. doi:10.4081/monaldi.2020.1292
12. Sahu KK, Lal A, Mishra AK. An update on CT chest findings in coronavirus disease-19
(COVID-19) [published online ahead of print, 2020 Mar 20]. Heart Lung. 2020;S0147-
9563(20)30094-7. doi:10.1016/j.hrtlng.2020.03.007.
13. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications
in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145‐147.
doi:10.1016/j.thromres.2020.04.013.
14. Wichmann D., Sperhake J.P., Lutgehetmann M. Autopsy findings and venous
thromboembolism in patients with COVID-19: a prospective cohort study. Ann. Intern.
Med. 2020
15. Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19
infection. A scoping review [published online ahead of print, 2020 May 27]. Thromb
Res. 2020;doi:10.1016/j.thromres.2020.05.039
16. Mishra AK, Sahu KK, Lal A. Reporting of all cardiac medications and their outcome in
COVID - 19 [published online ahead of print, 2020 Apr 8]. J Med Virol.
2020;10.1002/jmv.25843. doi:10.1002/jmv.25843.
17. Bangalore S, Sharma A, Slotwiner A, et al. ST-Segment Elevation in Patients with
Covid-19 - A Case Series [published online ahead of print, 2020 Apr 17]. N Engl J Med.
2020;NEJMc2009020. doi:10.1056/NEJMc2009020.
18. Bao C, Liu X, Zhang H, Li Y, Liu J. Coronavirus Disease 2019 (COVID-19) CT
Findings: A Systematic Review and Meta-analysis [published online ahead of print, 2020
Mar 25]. J Am Coll Radiol. 2020;S1546-1440(20)30262-3.
doi:10.1016/j.jacr.2020.03.006
19. Lal A, Mishra AK, Sahu KK. CT chest findings in coronavirus disease-19 (COVID-19). J
Formos Med Assoc. 2020;119(5):1000‐1001. doi:10.1016/j.jfma.2020.03.010
20. Mishra AK, Sahu KK, Lal A. Reporting of all cardiac medications and their outcome in
COVID - 19 [published online ahead of print, 2020 Apr 8]. J Med Virol.
2020;10.1002/jmv.25843. doi:10.1002/jmv.25843