Curso clínico de la COVID-19 en pacientes con hipertensión arterial pulmonar

COVID-19 in Pulmonary Artery Hypertension (PAH) Patients: Observations from a Large PAH Center in New York City

“…A small survey and other COVID-19 PAH/CTEPH series reported to date [ 5 , 6 , 7 , 8 ] have suggested that COVID-19 has a relatively benign course in the setting of PAH and surprisingly favorable clinical outcomes. Postulated mechanisms for the presumed low risk for severe COVID-19 included protective effects of known low ACE2 levels in PAH, resulting in decreased viral entrance in the lung cells, mitigation from the COVID-19 cytokine storm afforded by the chronic inflammatory milieu of PAH, or theoretical (and controversial) hemodynamic beneficial effects on the ventilation/perfusion matching in COVID pneumonia/ARDS of specific PAH medication [ 5 , 6 , 7 , 8 , 9 ]. A larger survey of 58 pulmonary hypertension comprehensive centers in the US showed more sobering findings with an estimated hospitalization rate of PAH/CTEPH patients with recognized COVID-19 of 30% and mortality of 12%, which are worse outcomes compared to those in general population [ 11 ].…”

“…In the early stages of the pandemic, when both medical knowledge and testing capabilities were suboptimal, some authors suggested relatively low incidence of COVID-19 in patients with PAH and CTEPH (chronic thromboembolic pulmonary hypertension). Additionally, in published series to date, PAH patients that developed COVID-19 had seemingly favorable clinical outcomes [ 5 , 6 , 7 , 8 ]. Pathophysiologic mechanisms that could explain the paucity of reported cases and the surprisingly favorable outcomes of COVID-19 in patients with PAH and CTEPH have been reviewed in detail [ 9 ].…”

COVID-19 Experience and Pulmonary Arterial Hypertension: Do Earlier Theses and New Data Still Match?

“…Nevertheless, it is our opinion that this information needs to be cautiously read in view of the number of patients included (70 and 50 in ERS and annals ATS, respectively), the high variability between patients' age, collection methods and mortality figures across the countries. Although PAH/CTEPH fatality rate is inevitably higher than in the general population, it is important to keep in mind that initial case-reports published at the beginning of this pandemic emphasized the surprisingly uneventful course of SARS-CoV-2 infection in these patients and efforts were made trying to explain these observations (4,5). We still have the impression, based in our own updated data with 38 COVID-19 confirmed cases in a cohort of 770 patients under follow-up, that their COVID-19 associated-risk continues to be lower than expected back in March 2020.…”

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

“… 1 , 4 , 5 Following the announcement of SARS‐CoV‐2 infection as a pandemic on March 11, 2020 by the World Health Organization (WHO), 6 different PH centers in Europe and the United States reported higher hospitalization and mortality rates due to COVID‐19 among PAH/CTEPH patients than in the general populations. 7 , 8 , 9 , 10 , 11 , 12 , 13 This may be due to the underlying medical conditions—namely chronic lung diseases and/or coronary heart diseases—and/or the reduced visits to PH centers during the pandemic, which delayed PH diagnosis and early detection of disease progression. 8 , 12 , 14 Vaccination against COVID‐19 should be prioritized in advanced PAH/CTEPH patients and PH patients waiting for lung transplant.…”

“…Chronic thromboembolic pulmonary hypertension (CTEPH) belongs to group 4 of clinical PH classification and is characterized by chronic pulmonary artery obstructions by thromboembolic material 1,4,5 . Following the announcement of SARS‐CoV‐2 infection as a pandemic on March 11, 2020 by the World Health Organization (WHO), 6 different PH centers in Europe and the United States reported higher hospitalization and mortality rates due to COVID‐19 among PAH/CTEPH patients than in the general populations 7–13 . This may be due to the underlying medical conditions—namely chronic lung diseases and/or coronary heart diseases—and/or the reduced visits to PH centers during the pandemic, which delayed PH diagnosis and early detection of disease progression 8,12,14 .…”