Unexpected Favourable Course of Coronavirus Disease 2019 in Chronic Thromboembolic Pulmonary Hypertension Patients

Cal, Teresa Segura de la; Nuche, Jorge; López-Guarch, Carmen Jiménez; Pérez‐Olivares, Carmen; Velázquez, Maite; López‐Medrano, Francisco; Gude, María Jesús López; Charterina, Sergio Alonso; Ynsaurriaga, Fernando Arribas; Escribano, Pilar

doi:10.1016/j.arbres.2020.06.004

Cited by 6 publications

(7 citation statements)

References 11 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%

“…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: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Information on outcomes of COVID-19 in pulmonary arterial hypertension (PAH) patients is limited to a few case series and surveys. Here, we describe our experience at a large Pulmonary Hypertension Center in New York City at the height of the pandemic. We performed a retrospective chart review of eleven consecutive PAH patients who were diagnosed with SARS-CoV-2 infection. We analyzed demographics, PAH severity, risk factors for COVID-19, and COVID-19 severity and outcomes. We found in our sample that 63.6% of patients required intensive care, and there was a 45.45% overall mortality. Most patients had a known COVID-19 contact and mean duration of symptoms prior to presentation was 12 days. Only 4/11 (36%) patients presented to a center with pulmonary hypertension expertise, all of whom survived. Most patients had at least moderate pulmonary hypertension with an average REVEAL score of 7.81 despite double or triple PAH therapy. Our cases series underscores the gravity of SARS-CoV-2 infection in patients with PAH. It also suggests possible interventions to prevent unfavorable outcomes such as preserving social distancing, PAH management optimization, and early and preferential presentation to a center with specialized expertise in PAH.

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Covid-19-induced pulmonary hypertension in children, and the use of phosphodiesterase-5 inhibitors

2021

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Respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first occurred in Wuhan, China, in December 2019 and was declared as a pandemic by WHO. The interaction between the 2019 coronavirus disease (COVID-19) and pulmonary hypertension (PH) in children is not widely known. Phosphodiesterase-5 inhibitors (PDEI), one class of drugs used to treat PH, including sildenafil, can suppress angiotensin type I (AT-1) receptor expression. Furthermore, it reduces proinflammatory cytokines and infiltrates the alveolar, inhibits endothelial and smooth muscle transition, mesenchymal cells in the pulmonary artery, and prevents clotting and thrombosis complications. Sildenafil has shown positive effects by diverting the blood flow to the lungs in such a way that ventilation is adequate and can also be anti-inflammatory.

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Unexpected Favourable Course of Coronavirus Disease 2019 in Chronic Thromboembolic Pulmonary Hypertension Patients

Cited by 6 publications

References 11 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

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

Covid-19-induced pulmonary hypertension in children, and the use of phosphodiesterase-5 inhibitors

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