Abstract
Introduction: Critically ill Covid-19 pneumonia patients are likely to develop the sequence of acute pulmonary hypertension, right ventricular (RV) strain, and eventually RV failure due to known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. This study aimed to investigate the occurrence of acute pulmonary hypertension (aPH) as per established trans-thoracic echocardiography (TTE) criteria in Covid-19 patients receiving intensive care and to explore whether short-term outcomes are affected by the presence of aPH.
Methods: Medical records were reviewed for patients treated in the intensive care units at a tertiary university hospital over a month. The presence of aPH on the TTE was noted, and plasma NTproBNP and troponin were measured as markers of cardiac failure and myocardial injury, respectively. Follow-up data were collected 21 d after the performance of TTE.
Results: In total, 26 of 67 patients (39%) had an assessed systolic pulmonary artery pressure of > 35 mmHg (group aPH), meeting the TTE definition of aPH. NTproBNP levels (median [range]: 1430 [102-30 300] vs. 470 [45-29 600] ng L -1 ; P = .0007), troponin T levels (63 [22-352] vs. 15 [5-407] ng L -1 ; P = .0002), and the 21-d mortality rate (46% vs. 7%; P < .001) were substantially higher in patients with aPH compared to patients not meeting aPH criteria.
Conclusion: TTE-defined acute pulmonary hypertension was frequently observed in severely ill Covid-19 patients. Furthermore, aPH was linked to biomarker-defined myocardial injury and cardiac failure, as well as an almost sevenfold increase in 21-d mortality.
Keywords: Covid-19; echocardiography; intensive care; outcome; prevalence; pulmonary hypertension; tricuspid valve regurgitation.
【저자키워드】 COVID-19, intensive care, outcome, Prevalence, echocardiography, pulmonary hypertension, tricuspid valve regurgitation., 【초록키워드】 Inflammation, COVID-19 pneumonia, Mortality, intensive care, intensive care unit, troponin, hypertension, echocardiography, intensive care units, myocardial injury, Critically ill, pathophysiology, Patient, troponin T, plasma, mortality rate, Intensive, patients, COVID-19 patients, marker, Embolism, pulmonary hypertension, criteria, medical records, medical record, cardiac failure, pulmonary artery, pulmonary artery pressure, endothelial, Vascular, pulmonary vascular resistance, tricuspid valve, university hospital, sequence, severely ill COVID-19 patients, acute pulmonary hypertension, Vascular resistance, tricuspid, Occurrence, affected, collected, develop, receiving, median, promote, increase in, were measured, patients treated, TTE, ventricular, 【제목키워드】 Patient,