arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2020-26-3-343-355arthyper-1983Research ArticleПРАКТИЧЕСКИЕ РЕКОМЕНДАЦИИPRACTICAL GUIDELINESРекомендации по диагностике и лечению пациентов с легочной гипертензией в условиях пандемии COVID-19Recommendations on the diagnosis and management of pulmonary hypertension during COVID-19 pandemichttps://orcid.org/0000-0001-9478-1941СимаковаМ. А.SimakovaM. A.

Симакова Мария Александровна — кандидат медицинских наук, старший научный сотрудник научно-исследовательского отдела некоронарогенных заболеваний сердца

ул. Аккуратова, д. 2, Санкт-Петербург, 197341Тел: 8(812)702–37–49, доб. 005927

Maria A. Simakova, MD, PhD, Senior Researcher, Research Department of Noncoronary Heart Disease

2 Akkuratov street, St Petersburg, 197341Phone: 8(812)702–37–49, ext. 005927

simakova_ma@almazovcentre.ruГончароваН. С.GoncharovaN. S.

Гончарова Наталья Сергеевна — кандидат медицинских наук, старший научный сотрудник научно-исследовательского отдела некоронарогенных заболеваний сердца

Санкт-Петербург

Natalya S. Goncharova, MD, PhD, Senior Researcher, Research Department of Noncoronary Heart Disease

St Petersburg

goncharova_ns@almazovcentre.ruКарповаД. В.KarpovaD. V.

Карпова Дарья Владимировна — врач-рентгенолог отделения компьютерной томографии

Санкт-Петербург

Darya V. Karpova, MD, Radiologist, Department of Computed Tomography

St Petersburg

karpova_dv@almazovcentre.ruКарелкинаЕ. В.KarelkinaE. V.

Карелкина Елена Викторовна — научный сотрудник научно-исследовательского отдела некоронарогенных заболеваний сердца

Санкт-Петербург

Elena V. Karelkina, MD, Researcher, Research Department of Noncoronary Heart Disease

St Petersburg

karelkina_ev@almazovcentre.ruМоисееваО. М.MoiseevaO. M.

Моисеева Ольга Михайловна — доктор медицинских наук, профессор, заведующая научно-исследовательским отделом некоронарогенных заболеваний сердца

Санкт-Петербург

Olga M. Moiseeva, MD, PhD, DSc, Professor, Head, Research Department of Noncoronary Heart Disease

St Petersburg

moiseeva_om@almazovcentre.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202016062020263343355Copyright © Симакова М.А., Гончарова Н.С., Карпова Д.В., Карелкина Е.В., Моисеева О.М., 20202020Симакова М.А., Гончарова Н.С., Карпова Д.В., Карелкина Е.В., Моисеева О.М.Simakova M.A., Goncharova N.S., Karpova D.V., Karelkina E.V., Moiseeva O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1983

Пациенты с легочной гипертензией чрезвычайно чувствительны к интеркуррентным респираторным заболеваниям, которые могут вызвать прогрессирование заболевания и ускорить наступление неблагоприятного исхода. Кроме того, отсутствие специфических симптомов и типичных клинических проявлений заболевания может затруднить верификацию диагноза и своевременное назначение специфической терапии пациентам с легочной артериальной гипертензией и хронической тромбоэмболической легочной гипертензией. Данная проблема становится наиболее острой в условиях пандемии COVID-19. В настоящем обзоре представлены алгоритмы дифференциальной диагностики легочных гипертензий при госпитализации пациента с подозрением на коронавирусную инфекцию, при этом особое внимание уделяется компьютерной томографии органов грудной клетки. Разработана удобная для практического использования таблица дифференциально-диагностических критериев изменений по типу «матового стекла» при компьютерной томографии у пациентов с легочной артериальной гипертензией, хронической тромбоэмболической легочной гипертензией, тромбоэмболией легочной артерии и COVID-19. Помимо этого, в статье изложены принципы выбора оптимальной терапии легочной артериальной гипертензии с учетом межлекарственных взаимодействий и осложнений, возникающих у больных с коронавирусной пневмонией.

Pulmonary hypertension patients are extremely sensitive to intercurrent respiratory infections which can cause disease progression and bring an adverse outcome closer. The absence of specific symptoms and typical clinical manifestations of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension makes it difficult to verify such diagnosis in time for early specific therapy prescription. This problem becomes more significant during the COVID-19 pandemic. This review presents diagnostic algorithms for differential diagnosis of pulmonary hypertension in a patient with suspected COVID-19 infection. In this term computed tomography (CT) of the chest deserves high attention. Differential diagnostic criteria for “frosted glass” type changes at CT-scan have been developed and can be used in everyday practice. Besides this, the article describes the principles of pulmonary arterial hypertension optimal therapy choice, taking into account drug interactions and complications occurring in COVID-19 patients.

легочная гипертензияпандемия COVID-19дифференциальный диагнозлечениединамическое наблюдениеpulmonary hypertensionCOVID-19 pandemicdifferential diagnosistreatmentfollow-upReferencesFrost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A et al. Diagnosis of pulmonary hypertension. Eur Respir J. 2019;53(1). pii:1801904. doi:10.1183/13993003.01904-2018.Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A et al. Diagnosis of pulmonary hypertension. Eur Respir J. 2019;53(1). pii:1801904. doi:10.1183/13993003.01904-2018.Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID - 19) Outbreak. J Autoimmun. 2020;109:102433. doi:10.1016/j.jaut.2020.102433Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID - 19) Outbreak. J Autoimmun. 2020;109:102433. doi:10.1016/j.jaut.2020.102433Временные методические рекомендации: профилактика, диагностика и лечение новой короновирусной инфекции (COVID-19). Версия 6 от 28.04.2020. 164 с.Temporary guidelines: prevention, diagnosis and treatment of new coronovirus infection (COVID - 19). Version 6 from 28.04.2020. 164 p. In Russian.ESC Guidance for the diagnosis and management of CV disease during the COVID-19 Pandemic. [Ahead of print, published online 21 April 2020]. [Electronic resource]. URL: https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC–COVID-19-GuidanceESC Guidance for the diagnosis and management of CV disease during the COVID-19 Pandemic. [Ahead of print, published online 21 April 2020]. [Electronic resource]. URL: https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC–COVID-19-GuidanceMercurio V, Peloquin G, Bourji KI, Diab N, Sato T, Enobun B et al. Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact. Pulm Circ. 2018;8(2):2045894018769874. doi:10.1177/2045894018769874Mercurio V, Peloquin G, Bourji KI, Diab N, Sato T, Enobun B et al. Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact. Pulm Circ. 2018;8(2):2045894018769874. doi:10.1177/2045894018769874Olsson KM, Nickel NP, Tongers J, Hoeper MM. Atrial flutter and fibrillation in patients with pulmonary hypertension. Int J Cardiol 2013;167(5):2300–2305. doi:10.1016/j.ijcard.2012.06.024Olsson KM, Nickel NP, Tongers J, Hoeper MM. Atrial flutter and fibrillation in patients with pulmonary hypertension. Int J Cardiol 2013;167(5):2300–2305. doi:10.1016/j.ijcard.2012.06.024Шляхто Е. В., Конради А. О., Арутюнов Г. П., Арутюнов А. Г., Баутин А. Е., Бойцов С. А. и др. Руководство по диагностике и лечению болезней системы кровообращения в контексте пандемии COVID-19. Российский кардиологический журнал. 2020;25(3):3801. doi:10.15829/1560-4071-2020-33801. doi:10.15829/1560-4071-2020-3-3801.Shlyakho EV, Konradi AO, Arutyunov GP, Arutyunov AG, Bautin AE, Boytsov SA et al. Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic. Russian Journal of Cardiology. 2020;25(3):3801. doi:10.15829/1560-4071-2020-3-3801. In Russian.Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119. doi:10.1093/eurheartj/ehv317Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119. doi:10.1093/eurheartj/ehv317Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2019;54(3):1901647. doi:10.1093/eurheartj/ehz405Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2019;54(3):1901647. doi:10.1093/eurheartj/ehz405Shen Y, Wan C, Tian P, Wu Y, Li X, Yang T et al. CT-base pulmonary artery measurement in the detection of pulmonary hypertension: a meta-analysis and systematic review. Medicine (Baltimore). 2014;93(27):e256. doi:10.1097/MD.0000000000000256Shen Y, Wan C, Tian P, Wu Y, Li X, Yang T et al. CT-base pulmonary artery measurement in the detection of pulmonary hypertension: a meta-analysis and systematic review. Medicine (Baltimore). 2014;93(27):e256. doi:10.1097/MD.0000000000000256Rajaram S, Swift AJ, Condliffe R, Johns C, Elliot CA, Hill C et al. CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry. Thorax. 2015;70(4):382–387. doi:10.1136/thoraxjnl-2014-206088Rajaram S, Swift AJ, Condliffe R, Johns C, Elliot CA, Hill C et al. CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry. Thorax. 2015;70(4):382–387. doi:10.1136/thoraxjnl-2014-206088Tunariu N, Gibbs SJR, Win Z, Gin-Sing W, Graham A, Gishen P et al. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med. 2007;48(5):680–4. doi:10.2967/jnumed.106.039438Tunariu N, Gibbs SJR, Win Z, Gin-Sing W, Graham A, Gishen P et al. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med. 2007;48(5):680–4. doi:10.2967/jnumed.106.039438Reichelt A, Hoeper MM, Galanski M, Keberle M. Chronic thromboembolic pulmonary hypertension: evaluation with 64-detector row CT versus digital substraction angiography. Eur J Radiol. 2009 Jul;71(1):49–54. doi:10.1016/j.ejrad.2008.03.016Reichelt A, Hoeper MM, Galanski M, Keberle M. Chronic thromboembolic pulmonary hypertension: evaluation with 64-detector row CT versus digital substraction angiography. Eur J Radiol. 2009 Jul;71(1):49–54. doi:10.1016/j.ejrad.2008.03.016Zuckier LS, Moadel RM, Haramati LB, Freeman LM. Diagnostic evaluation of pulmonary embolism during the COVID-19 pandemia. J Nucl Med. 2020;61(5):630–631. doi:10.2967/jnumed.120.245571Zuckier LS, Moadel RM, Haramati LB, Freeman LM. Diagnostic evaluation of pulmonary embolism during the COVID-19 pandemia. J Nucl Med. 2020;61(5):630–631. doi:10.2967/jnumed.120.245571Price LC, Wort SJ. Pulmonary hypertension in ARDS: inflammation matters! Thorax. 2017;72(5):396–397. doi:10.1136/thoraxjnl-2016-209199Price LC, Wort SJ. Pulmonary hypertension in ARDS: inflammation matters! Thorax. 2017;72(5):396–397. doi:10.1136/thoraxjnl-2016-209199Padang R, Chandrashekar N, Indrabhinduwat M, Scott CG, Luis SA, Chandrasekaran K, et al. Aetiology and outcomes of severe right ventricular dysfunction. Eur Heart J. 2020;41(12):1273–1282. doi:10.1093/eurheartj/ehaa037Padang R, Chandrashekar N, Indrabhinduwat M, Scott CG, Luis SA, Chandrasekaran K, et al. Aetiology and outcomes of severe right ventricular dysfunction. Eur Heart J. 2020;41(12):1273–1282. doi:10.1093/eurheartj/ehaa037Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi:10.1056/NEJMoa2002032Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi:10.1056/NEJMoa2002032Sarkar MS, Desai PM. Pulmonary hypertension and cardiac anesthesia: Anesthesiologist’s perspective. Ann Card Anaesth 2018;21(2):116–122. doi:10.4103/aca.ACA_123_17Sarkar MS, Desai PM. Pulmonary hypertension and cardiac anesthesia: Anesthesiologist’s perspective. Ann Card Anaesth 2018;21(2):116–122. doi:10.4103/aca.ACA_123_17Ryan J, Melendres-Groves L, Zamanian RT, Oudiz RJ, Chakinala M, Rosenzweig EB, Gomberg-Maitland M. Care of patients with pulmonary arterial hypertension during the coronavirus (COVID-19) pandemic Pulm Circulation. 2020;10(2): 2045894020920153. doi:10.1177/2045894020920153Ryan J, Melendres-Groves L, Zamanian RT, Oudiz RJ, Chakinala M, Rosenzweig EB, Gomberg-Maitland M. Care of patients with pulmonary arterial hypertension during the coronavirus (COVID-19) pandemic Pulm Circulation. 2020;10(2): 2045894020920153. doi:10.1177/2045894020920153Benza RL, Gomberg-Maitland M, Elliott CG, Farber HW, Foreman AJ, Frost AE et al. Predicting survival in patients with pulmonary arterial hypertension: the REVEAL Risk Score Calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies. Chest. 2019;156(2):323–337. doi:10.1016/j.chest.2019.02.004Benza RL, Gomberg-Maitland M, Elliott CG, Farber HW, Foreman AJ, Frost AE et al. Predicting survival in patients with pulmonary arterial hypertension: the REVEAL Risk Score Calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies. Chest. 2019;156(2):323–337. doi:10.1016/j.chest.2019.02.004Hoeper MM, Benza RL, Corris P, de Perrot M, Fadel E, Keogh AM et al. Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension. Eur Respir J. 2019;53(1):1801906. doi:10.1183/13993003.01906-2018Hoeper MM, Benza RL, Corris P, de Perrot M, Fadel E, Keogh AM et al. Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension. Eur Respir J. 2019;53(1):1801906. doi:10.1183/13993003.01906-2018Гончарова Н. С., Симакова М. А., Моисеева О. М. Антитромботическая терапия у пациентов с легочной артериальной гипертензией. Артериальная гипертензия. 2019;25(1):25–33. doi:10.18705/1607-419X-2019-25-1-25-33Goncharova NS, Simakova МA, Moiseeva OM. Antithrombotic therapy in patients with pulmonary arterial hypertension. Arterial’naya Gipertenziya = Arterial Hypertension. 2019;25(1):25–33. In Russian.Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–847. doi:10.1111/jth.14768Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–847. doi:10.1111/jth.14768Sitbon O, Bosch J, Cottreel E, Csonka D, de Groote P, Hoeper MM, et al. Macitentan for the treatment of portopulmonary hypertension (PORTICO): a multicentre, randomised, double-blind, placebo-controlled, phase 4 trial. Lancet Respir Med. 2019;7(7):594–604. doi:10.1016/S2213-2600(19)30091-8Sitbon O, Bosch J, Cottreel E, Csonka D, de Groote P, Hoeper MM, et al. Macitentan for the treatment of portopulmonary hypertension (PORTICO): a multicentre, randomised, double-blind, placebo-controlled, phase 4 trial. Lancet Respir Med. 2019;7(7):594–604. doi:10.1016/S2213-2600(19)30091-8Degano B, Yaïci A, Le Pavec J, Savale L, Jaïs X, Camara B et al. Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension. Eur Respir J. 2009;33(1):92–98. doi:10.1183/09031936.00094808Degano B, Yaïci A, Le Pavec J, Savale L, Jaïs X, Camara B et al. Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension. Eur Respir J. 2009;33(1):92–98. doi:10.1183/09031936.00094808Gupta M, Kovar A, Meibohm B. The clinical pharmacokinetics of phosphodiesterase-5 inhibitors for erectile dysfunction. J Clin Pharmacol. 2005;45(9):987–1003. doi:10.1177/0091270005276847Gupta M, Kovar A, Meibohm B. The clinical pharmacokinetics of phosphodiesterase-5 inhibitors for erectile dysfunction. J Clin Pharmacol. 2005;45(9):987–1003. doi:10.1177/0091270005276847Chinello P, Cicalini S, Pichini S, Pacifici R, Tempestilli M, Cecini M et al. Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus-infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor. Infect Dis Rep. 2015;7(1):5822. doi:10.4081/idr.2015.5822Chinello P, Cicalini S, Pichini S, Pacifici R, Tempestilli M, Cecini M et al. Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus-infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor. Infect Dis Rep. 2015;7(1):5822. doi:10.4081/idr.2015.5822Ciracì R, Tirone G, Scaglione F. The impact of drug-drug interactions on pulmonary arterial hypertension therapy. Pulm Pharmacol Ther. 2014;28(1):1–8. doi:10.1016/j.pupt.2014.01.004.Ciracì R, Tirone G, Scaglione F. The impact of drug-drug interactions on pulmonary arterial hypertension therapy. Pulm Pharmacol Ther. 2014;28(1):1–8. doi:10.1016/j.pupt.2014.01.004.

The authors declare that there are no conflicts of interest present.