Sequelae of COVID-19 at long-term after

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge.Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI "National Medical Research Center of Cardiology" of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale.Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8 +/- 12.5, median 57 years [49.0;64.0];men, 55.4%) agreed come for an outpatient visit and to participate in the "COVID-19-follow-up" program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%;10/17) had CVDrelated hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) - coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance.Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

Sequelae of COVID-19 at long-term follow-up after hospitalization

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge. Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI “National Medical Research Center of Cardiology” of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale. Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8±12.5, median 57 years [49.0;64.0];men, 55.4%) agreed come for an outpatient visit and to participate in the “COVID-19-follow-up” program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%;10/17) had CVD-related hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) – coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance. Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

Case report of mild form of a new coronavirus infection in patient with idiopathic pulmonary hypertension.

The article presents a clinical case of mild novel coronavirus infection COVID-19 complicated with bilateral interstitial pneumonia in a female patient with idiopathic pulmonary hypertension.

Delayed ct scan of the lungs in patients with covid-19 pneumonia

Purpose. Assessment the state of the lungs using CT in the dynamic follow-up of pa-tients who have suffered from viral COVID-19 pneumonia in the delayed period af-ter 6-10 months, and to identify the relationship of residual lung changes with the clinical condition and results of external respiratory function (ERF). Materials and methods. We examined 78 patients who had suffered from bilateral polysegmental viral COVID-19 pneumonia in April-May 2020, using multi-spiral computed tomography (CT) of the lungs. All patients had a medical history, performed CT scans of the lungs in the acute and delayed (6-10 months after hospitalization) phases, and a study of FVD in the delayed phase. The analysis of a series of tomograms of the lungs in dynamics was carried out. We developed an severity score of the lung condition (LungSS), expressed in the total score, which was calculated based on the score of typical patterns characteristic of viral Covid19-pneumonia, as well as residual changes and areas of fibrosis. LungSS was calculated for each patient in the acute and delayed follow-up periods. Results. The present study shows the dynamics of lung changes in the delayed peri-od 6-10 months after the viral Covid19-pneumonia. Residual lung changes were detected in 66 people (84,6%). Of these, 35,9% of patients have areas of fibrosis, but most of the residu-al changes are linear and small-nodular seals (76,9%). The frequency of detection of residual reticular changes and consolidation was low (15,3%, 1,3%, respectively). Attention is drawn to the relatively frequent detection of areas of "Ground-glass opacity "(10,8%). In patients with severe and critical course of viral Covid19-pneumonia (CT3 and CT4), LungSS in the delayed follow-up period did not significantly differ from that in patients with mild and mod-erate course (CT1 and CT2) of the disease (4,5 [0,22], 2,5 [0,16], accordingly, p=0,61). There was no significant correlation between the detected residual lung changes in the delayed period and ERF. Conclusion. In a significant part of patients (84,6%) who have suffered from COVID-19 viral pneumonia, residual changes in the lung parenchyma persist, mainly in the form of linear seals and to a lesser extent fibrosis. These changes did not have a reliable relation-ship with the results of the FVD. LungSS proposed in this study reflects the dynamic picture of lung changes in the acute and delayed period, and can be a good indicator for monitoring patients who have suffered from COVID-19 viral pneumonia.

Chest computed tomography in diagnosis of a new coronavirus infection in a patient with a negative result of laboratory testing

urpose. The demonstration of the informativeness of chest computed tomography (CT) to detect pathological changes in the lungs typical for a new coronavirus infection (COVID-19). Results. The report presents a clinical case of using chest CT for the diagnosis of COVID-19 in a 67-year-old patient with clinical signs of lung damage and a negative result of laboratory test using the method of reverse transcription polymerase chain reaction (RT-PCR). Discussion. Compared to RT-PCR, chest CT has high sensitivity in the diagnosis of inflammatory changes in the lungs typical for COVID-19, but low specificity. An indication for chest CT in a negative result of laboratory testing for COVID-19 is the presence of signs of moderate or severe lung damage in patients with a clinical picture typical for this disease. Conclusion. The clinical case demonstrates the importance of using chest CT in identifying patients with COVID-19, especially in the presence of characteristic clinical manifestations of this disease and a negative result of laboratory testing using the method of RT-PCR. © 2020 Russian Electronic Journal of Radiology. All rights reserved.