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Published on: November 18, 2018
Pulmonary Hypertension and COVID-19
Laura Castiglione1, Michal Droppa1
1Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany.
Insights
COVID-19 can cause pulmonary hypertension (PH), a serious condition affecting lung blood flow. Early research suggests inhaled vasodilators may help treat this complication, but more clinical trials are needed.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) is a global pandemic with potential cardiovascular and pulmonary complications.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce pulmonary hypertension (PH) through endothelial dysfunction and thrombotic microangiopathy.
- Approximately 12-13% of hospitalized COVID-19 patients exhibit echocardiographic signs of PH, indicating a significant association with disease severity and adverse outcomes.
Purpose of the Study:
- To explore the potential therapeutic benefits of inhaled vasodilators in managing COVID-19-associated pulmonary hypertension.
- To investigate the role of pulmonary hemodynamics in the pathophysiology of COVID-19.
- To summarize current evidence on PH in COVID-19 patients and potential treatment strategies.
Main Methods:
- Review of clinical research and available studies on COVID-19 and pulmonary hypertension.
- Analysis of echocardiographic data in hospitalized COVID-19 patients.
- Evaluation of the effects of inhaled vasodilators, such as nitric oxide and prostacyclin.
Main Results:
- Inhaled vasodilators like nitric oxide and prostacyclin have shown promising results in improving oxygenation and reducing pulmonary arterial pressure.
- Treatment with inhaled vasodilators may help prevent right ventricular failure in COVID-19 patients with PH.
- Existing studies indicate a link between PH and increased COVID-19 severity and poorer prognosis.
Conclusions:
- Pulmonary hypertension is a significant complication of COVID-19, linked to worse patient outcomes.
- Inhaled vasodilators represent a potential therapeutic avenue for COVID-19-related PH, warranting further investigation.
- Randomized controlled trials are necessary to confirm the efficacy and safety of inhaled vasodilators in this patient population.
Abstract:
Coronavirus disease 2019 (COVID-19) is a primary respiratory infectious disease, which can result in pulmonary and cardiovascular complications. From its first appearance in the city of Wuhan (China), the infection spread worldwide, leading to its declaration as a pandemic on March 11, 2020. Clinical research on SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) suggests that the virus may determine changes in the pulmonary hemodynamics through mechanisms of endothelial dysfunction, vascular leak, thrombotic microangiopathy, and venous thromboembolism that are similar to those leading to pulmonary hypertension (PH). Current available studies report echocardiographic signs of PH in approximately 12 to 13% of hospitalized patients with COVID-19. Those with chronic pulmonary obstructive disease, congestive heart failure, pulmonary embolism, and prior PH are at increased risk to develop or worsen PH. Evidence of PH seems to be associated with increased disease severity and poor outcome. Because of the importance of the pulmonary hemodynamics in the pathophysiology of COVID-19, there is growing interest in exploring the potential therapeutical benefits of inhaled vasodilators in patients with COVID-19. Treatment with inhaled nitric oxide and prostacyclin has shown encouraging results through improvement of systemic oxygenation, reduction of systolic pulmonary arterial pressure, and prevention of right ventricular failure; however, data from randomized control trials are still required.
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