Nearly a Third of COVID-19 Patients Show PH Signs in Study
Nearly a third (29.7%) of COVID-19 patients showed signs of pulmonary hypertension (PH) on an echocardiogram — a scan of heart movement — according to a study in the Netherlands.
While mortality rates were significantly higher among those with suspected PH than those without it, follow-up tests suggested that signs of PH were reversible in surviving patients.
The findings suggest estimated PH may be a prognostic risk factor in COVID-19 patients, the researchers said, adding that “vigilant attention” should be paid for signs of PH in this population.
The study, “Echo cardiographic estimation of pulmonary hypertension in COVID-19 patients,” was published in the Netherlands Heart Journal.Â
While most cases of COVID-19 show mild symptoms, a minority of patients have more severe outcomes, including respiratory failure and other cardiovascular complications.
PH is marked by increased blood pressure in the arteries supplying blood from the heart to the lungs (pulmonary artery), leading to shortness of breath, chest pain, and heart problems, among other symptoms.
A few studies have suggested that viral infections, such as COVID-19 can lead to inflammation that drives PH. But the true prevalence of PH after COVID-19 infection has not been thoroughly evaluated.
A research team in the Netherlands investigated the prevalence of signs of PH among COVID-19 patients at its clinic and whether PH influenced their prognosis.
Overall, 101 patients (mean age, 66) with a confirmed COVID-19 infection who were seen at Zuyderland Medical Centre, the Netherlands, between September 2020 and November 2020 were included in the study.
Across all 101 patients, 80 were admitted to the hospital and 30 into the intensive care unit. Sixteen required artificial ventilation. On average, hospital stays were 21 days.
An echocardiography assessed for signs of PH. Overall, 30 patients, with a mean age of 70.9, were estimated to have the condition — nearly 30% of all evaluated patients. PH patients were significantly older than other patients.
The echocardiography was performed an average of 63 days after a COVID-19 diagnosis. This delay was significantly shorter in those diagnosed with PH compared with those not diagnosed with it.
The presence of heart valve disease — encompassing dysfunction of any of the heart’s four valves — was significantly correlated with the presence of PH. No other coexisting conditions or laboratory tests differed between the two groups.
The mortality rate was significantly higher among those with PH, with deaths occurring in one-third of PH patients compared with 12.7% of those without it.
Average right ventricular systolic pressure (RVSP), an estimate of pressure in the pulmonary arteries measured using an echocardiography, was higher among those with estimated PH compared with other patients.
In 10 out of 20 surviving PH patients who received a follow-up echocardiogram, RVSP values significantly decreased after a median of 144 days, suggesting PH may be “partly reversible,” the researchers said.
The findings suggest COVID-19 patients may be at significant risk for PH, and those who develop it may be at a higher mortality risk.
The researchers noted that because an echocardiography was not performed prior to COVID-19 infection, it can’t be determined whether some patients had PH prior to having the virus. A small sample size undergoing a repeat echocardiography also marks a limitation, they added.
Nonetheless, “we suggest vigilant attention to relevant symptoms and a low threshold for echocardiography in COVID-19 patients, with special attention to the possible detection of PH,” the researchers wrote.
PH in COVID-19 may arise from multiple factors, including widespread inflammation caused by the infection, the researchers hypothesized. That valvular heart disease was correlated with PH in this group also suggests “a cardiac factor predisposing COVID-19 patients to developing PH,” they wrote.
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