Clinical course of COVID-19 in pulmonary arterial hypertension patients

Nuche, Jorge; Pérez‐Olivares, Carmen; Cal, Teresa Segura de la; López-Guarch, Carmen Jiménez; Arribas, Fernando; Escribano, Pilar

doi:10.1016/j.rec.2020.05.015

Cited by 26 publications

(34 citation statements)

References 6 publications

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“…This observation may be explained by the low prevalence of these diseases and by the increased awareness of chronic patients with a special emphasis on social-distancing measure compliances [ 71 , 72 ]. However, we have recently published our surprisingly positive experience with COVID-19 in our PAH [ 15 ] and CPTEH [ 17 ] populations without any of them requiring intensive care and any deaths reported. Furthermore, a similar benign course has been observed in other centers [ 16 , 73 ], with no published reports suggesting particularly adverse outcomes [ 74 ] ( Figure 2 ).…”

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

“…Although our observations of a benign course in PAH and CTEPH patients requires caution, we described some pathophysiological characteristics that could explain this benign course [ 15 , 17 ].…”

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

“…Two different hypotheses could explain the role of this chronic inflammatory status in the reduction of COVID-19 severity. First, the presence of this extra-immune perivascular and perialveolar system layer (“tertiary lymphoid tissue”), which could limit the viral infection and expansion [ 15 ]. However, this protective effect has not been reported for other bacterial or viral infections in PAH and CTEPH patients, and they are considered a high-risk population, with an indication for vaccination against Streptococcus pneumoniae and for annual vaccinations against influenza [ 5 ].…”

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

“…We have previously hypothesized that this reduced ACE2 expression could confer a protective status for this population, due to a reduced viral capacity to infect pneumocytes [ 15 , 17 ]. However, since ACE2 has also a protective effect on endothelial cells, the previously described dilemma takes special interest in this matter [ 59 ].…”

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

“…Noteworthy, some case-series have repeatedly presented the unexpected favorable outcome of COVID-19 infection in this population, suggesting that these patients could be somehow protected against severe forms of the disease [ 15 , 16 , 17 ]. However, whether this protection is due to receiving therapy, to their special awareness about their particular risk factor or to any other physiological condition related to the disease is still a remaining question.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension

et al. 2020

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The Coronavirus Disease of 2019 (COVID-19) has supposed a global health emergency affecting millions of people, with particular severity in the elderly and patients with previous comorbidities, especially those with cardiovascular disease. Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) could represent an especially vulnerable population because of the high mortality rates reported for respiratory infections. However, the number of COVID-19 cases reported among PAH and CTEPH patients is surprisingly low. Furthermore, the clinical picture that has been described in these patients is far from the severity that experts would expect. Endothelial dysfunction is a common feature between patients with PAH/CTEPH and COVID-19, leading to ventilation/perfusion mismatch, vasoconstriction, thrombosis and inflammation. In this picture, the angiotensin-converting enzyme 2 plays an essential role, being directly involved in the pathophysiology of both clinical entities. Some of these common characteristics could explain the good adaptation of PAH and CTEPH patients to COVID-19, who could also have obtained a benefit from the disease’s specific treatments (anticoagulant and pulmonary vasodilators), probably due to its protective effect on the endothelium. Additionally, these common features could also lead to PAH/CTEPH as a potential sequelae of COVID-19. Throughout this comprehensive review, we describe the similarities and differences between both conditions and the possible pathophysiological and therapeutic-based mechanisms leading to the low incidence and severity of COVID-19 reported in PAH/CTEPH patients to date. Nevertheless, international registries should look carefully into this population for better understanding and management.

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Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension

et al. 2020

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The impact of COVID‐19 pandemic on pulmonary hypertension: What have we learned?

et al. 2022

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The coronavirus 2019 disease (COVID‐19) pandemic threatened the Spanish health‐care system. Patients with demanding conditions such as precapillary pulmonary hypertension (PH) faced a potentially severe infection, while their usual access to medical care was restricted. This prospective, unicentric study assessed the impact of COVID‐19 on PH patients' outcomes and the operational changes in the PH network. Sixty‐three PH patients (41 pulmonary arterial hypertension [PAH]; 22 chronic thromboembolic pulmonary hypertension [CTEPH]) experienced COVID‐19. Overall mortality was 9.5% without differences when stratifying by hemodynamics or PAH‐risk score. Patients who died were older (73.6 ± 5 vs. 52.2 ± 15.4; p = 0.001), with more comorbidities (higher Charlson index: 4.17 ± 2.48 vs. 1.14 ± 1.67; p = 0.0002). Referrals to the PH expert center decreased compared to the previous 3 years (123 vs. 160; p = 0.002). The outpatient activity shifted toward greater use of telemedicine. Balloon pulmonary angioplasty activity could be maintained after the first pandemic wave and lockdown while pulmonary thromboendarterectomy procedures decreased (19 vs. 36; p = 0.017). Pulmonary transplantation activity remained similar. The COVID‐19 mortality in PAH/CTEPH patients was not related to hemodynamic severity or risk stratification, but to comorbidities. The pandemic imposed structural changes but a planned organization and resource reallocation made it possible to maintain PH patients' care.

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Long COVID syndrome after SARS‐CoV‐2 survival in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Wieteska¹,

Kuśmierczyk‐Droszcz

Betkier-Lipińska

et al. 2023

Pulm. circ.

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Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients have a more severe COVID‐19 course than the general population. Many patients report different persistent symptoms after SARS‐CoV‐2 infection. The aim of our study is to analyze the prevalence of long COVID‐19 symptoms and assess if COVID‐19 affects pulmonary hypertension (PH) prognosis. PAH/CTEPH patients who survived COVID‐19 for at least 3 months before visiting the PH centers were included in the study. The patients were assessed for symptoms in acute phase of SARS‐CoV‐2 infection and persisting in follow‐up visit, WHO functional class, 6‐min walk distance, NT‐proBNP concentration. The COMPERA 2.0 model was used to calculate 1‐year risk of death due to PH at baseline and at follow‐up. Sixty‐nine patients—54 (77.3%) with PAH and 15 (21.7%) with CTEPH, 68% women, with a median age of 47.5 years (IQR 37–68)—were enrolled in the study. About 17.1% of patients were hospitalized due to COVID‐19 but none in an ICU. At follow‐up (median: 155 days after onset of SARS‐CoV‐2 symptoms), 62% of patients reported at least 1 COVID‐19‐related symptom and 20% at least 5 symptoms. The most frequently reported symptoms were: fatigue (30%), joint pain (23%), muscle pain (17%), nasal congestion (17%), anosmia (13%), insomnia (13%), and dyspnea (12%). Seventy‐two percent of PH patients had a low or intermediate‐low risk of 1‐year death due to PH at baseline, and 68% after COVID‐19 at follow‐up. Over 60% of PAH/CTEPH patients who survived COVID‐19 suffered from long COVID‐19 syndrome, but the calculated 1‐year risk of death due to PH did not change significantly after surviving mild or moderate COVID‐19.

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Clinical course of COVID-19 in pulmonary arterial hypertension patients

Cited by 26 publications

References 6 publications

Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension

Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension

The impact of COVID‐19 pandemic on pulmonary hypertension: What have we learned?

Long COVID syndrome after SARS‐CoV‐2 survival in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

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