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Recommendations on the diagnosis and management of pulmonary hypertension during COVID-19 pandemic

https://doi.org/10.18705/1607-419X-2020-26-3-343-355

Abstract

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.

About the Authors

M. A. Simakova
Almazov National Medical Research Centre
Russian Federation

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

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



N. S. Goncharova
Almazov National Medical Research Centre
Russian Federation

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

St Petersburg



D. V. Karpova
Almazov National Medical Research Centre
Russian Federation

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

St Petersburg



E. V. Karelkina
Almazov National Medical Research Centre
Russian Federation

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

St Petersburg



O. M. Moiseeva
Almazov National Medical Research Centre
Russian Federation

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

St Petersburg



References

1. 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.

2. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID - 19) Outbreak. J Autoimmun. 2020;109:102433. doi:10.1016/j.jaut.2020.102433

3. Temporary guidelines: prevention, diagnosis and treatment of new coronovirus infection (COVID - 19). Version 6 from 28.04.2020. 164 p. In Russian.

4. 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-Guidance

5. Mercurio 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:10.1177/2045894018769874

6. Olsson 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.2012.06.024

7. 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.

8. 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/ehv317

9. Konstantinides 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/ehz405

10. Shen 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.0000000000000256

11. Rajaram 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-2014-206088

12. Tunariu 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.106.039438

13. Reichelt 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.2008.03.016

14. Zuckier 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.120.245571

15. Price LC, Wort SJ. Pulmonary hypertension in ARDS: inflammation matters! Thorax. 2017;72(5):396–397. doi:10.1136/thoraxjnl-2016-209199

16. Padang 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/ehaa037

17. Guan 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/NEJMoa2002032

18. Sarkar 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_17

19. Ryan 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:10.1177/2045894020920153

20. Benza 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.2019.02.004

21. Hoeper 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:10.1183/13993003.01906-2018

22. Goncharova 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.

23. 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.14768

24. Sitbon 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)30091-8

25. Degano 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:10.1183/09031936.00094808

26. Gupta M, Kovar A, Meibohm B. The clinical pharmacokinetics of phosphodiesterase-5 inhibitors for erectile dysfunction. J Clin Pharmacol. 2005;45(9):987–1003. doi:10.1177/0091270005276847

27. Chinello 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.2015.5822

28. 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.


Review

For citations:


Simakova M.A., Goncharova N.S., Karpova D.V., Karelkina E.V., Moiseeva O.M. Recommendations on the diagnosis and management of pulmonary hypertension during COVID-19 pandemic. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2020;26(3):343-355. (In Russ.) https://doi.org/10.18705/1607-419X-2020-26-3-343-355

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ISSN 1607-419X (Print)
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