Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19

Matteo Pagnesi, Luca Baldetti, Alessandro Beneduce, Francesco Calvo, Mario Gramegna, Vittorio Pazzanese, Giacomo Ingallina, Antonio Napolano, Renato Finazzi, Annalisa Ruggeri, Silvia Ajello, Giulio Melisurgo, Paolo Guido Camici, Paolo Scarpellini, Moreno Tresoldi, Giovanni Landoni, Fabio Ciceri, Anna Mara Scandroglio, Eustachio Agricola, Alberto Maria Cappelletti, Matteo Pagnesi, Luca Baldetti, Alessandro Beneduce, Francesco Calvo, Mario Gramegna, Vittorio Pazzanese, Giacomo Ingallina, Antonio Napolano, Renato Finazzi, Annalisa Ruggeri, Silvia Ajello, Giulio Melisurgo, Paolo Guido Camici, Paolo Scarpellini, Moreno Tresoldi, Giovanni Landoni, Fabio Ciceri, Anna Mara Scandroglio, Eustachio Agricola, Alberto Maria Cappelletti

Abstract

Objective: To assess the prevalence, characteristics and prognostic value of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in hospitalised, non-intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).

Methods: This single-centre, observational, cross-sectional study included 211 patients with COVID-19 admitted to non-ICU departments who underwent a single transthoracic echocardiography (TTE). Patients with poor acoustic window (n=11) were excluded. Clinical, imaging, laboratory and TTE findings were compared in patients with versus without PH (estimated systolic pulmonary artery pressure >35 mm Hg) and with versus without RVD (tricuspid annular plane systolic excursion <17 mm or S wave <9.5 cm/s). The primary endpoint was in-hospital death or ICU admission.

Results: A total of 200 patients were included in the final analysis (median age 62 (IQR 52-74) years, 65.5% men). The prevalence of PH and RVD was 12.0% (24/200) and 14.5% (29/200), respectively. Patients with PH were older and had a higher burden of pre-existing cardiac comorbidities and signs of more severe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (radiological lung involvement, laboratory findings and oxygenation status) compared with those without PH. Conversely, patients with RVD had a higher burden of pre-existing cardiac comorbidities but no evidence of more severe SARS-CoV-2 infection compared with those without RVD. The presence of PH was associated with a higher rate of in-hospital death or ICU admission (41.7 vs 8.5%, p<0.001), while the presence of RVD was not (17.2 vs 11.7%, p=0.404).

Conclusions: Among hospitalised non-ICU patients with COVID-19, PH (and not RVD) was associated with signs of more severe COVID-19 and with worse in-hospital clinical outcome.

Trial registration number: NCT04318366.

Keywords: echocardiography; pulmonary vascular disease.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
In-hospital all-cause mortality or ICU admission in COVID-19 with or without PH and RVD. The figure shows Kaplan-Meier curves for in-hospital all-cause mortality or ICU admission in patients with COVID-19 with versus without PH (A) and with versus without RVD (B). ICU, intensive care unit; PH, pulmonary hypertension; RVD, right ventricular dysfunction.

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Source: PubMed

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