ABSTRACT
During SARS-CoV-2 infection, acute pulmonary embolism (PE) worsens the patient's clinical status. However, after resolution of the acute phase, the impact of residual thrombotic lesions in pulmonary vasculature remains unknown. In this line, chronic thromboembolic disease (CTD) consists of persistent thrombotic lesions and involves long-term functional limitations, including those for patients with a CTD with or without chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to evaluate the prevalence of CTD after hospitalization for SARSCoV-2 pneumonia and PE. Also, we evaluated the clinical and functional characteristics of these patients. Forty-two patients diagnosed of PE in the course of SARS-CoV-2 pneumonia were included. In all patients, CT angiography (n=35) and/or pulmonary V/Q scan (n=19) was obtained between 3 to 4 months after discharge. Remaining symptoms, pulmonary function and exercise capacity also were evaluated. Eleven patients (26%) showed persistent thrombotic lesions without residual SARS-CoV-2 pneumonia images. Within this former group, 36% (n=4) had exertional dyspnea as expression of CTD. Only one patient (9%) developed CTEPH. The only related factor with persistent thrombotic lesions was older age (>70 years). Exercise capacity and pulmonary function were not significantly different between symptomatic and non-symptomatic patients. Residual thrombotic lesions are a frequent finding after SARS-CoV-2 infection, however the prevalence of CTD and CTEPH are similar to SARS-CoV-2 non-related acute pulmonary embolism. In this patients, the current recommendations for pulmonary embolism monitoring after discharge could be applied.
ABSTRACT
Background: Persisting symptoms after SARS-COV-2 infection (COVID-19) have been widely reported in patients with critical disease, but also in those with mild or moderate illness. Our objective was to describe clinical characteristics, symptoms and the impact of treatment received in the acute phase in a cohort of postCOVID-19 patients at one-year follow-up according to their severity. Method(s): Outpatients with ongoing symptoms and those that required hospitalization were visited in the PostCOVID Unit from March 2020 to June 2021. A standardized symptom questionnaire was performed in the follow-up visit and demographic, clinical data and treatment received during the infection were collected. Subjects were divided according to their infection severity and data were compared. Result(s): At one-year of follow-up, 1966 patients were evaluated in the Post-COVID Unit of our center;1081 had mild infection, 542 moderate and 343 severe. At 12-month follow-up 728 (37%) subjects had persistent symptoms, being more frequent in mild disease compared to moderate and severe illness. The most common symptoms were dyspnea 472 (24%), fatigue 391 (19.8%), myalgia 237 (12%), anxiety 227 (11.5%) depressive symptoms 198 (10%) and memory loss 177 (8.9%). Subjects that received steroids, tocilizumab or remdesivir, presented a lower median (IQ) symptom duration [134 (64-256) vs. 258 (217-304) days, p<0.001]. Conclusion(s): Persisting symptoms are frequent after SARS-CoV-2 infection, also in less severe disease. Treatment received could have an impact on symptoms duration. Follow-up after discharge in specialized multidisciplinary postCOVID19 units is needed.