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Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients have a more severe COVID-19 course than the general population. Many patients report different persistent symptoms after SARS-CoV-2 infection. The aim of our study is to analyze the prevalence of long COVID-19 symptoms and assess if COVID-19 affects pulmonary hypertension (PH) prognosis. PAH/CTEPH patients who survived COVID-19 for at least 3 months before visiting the PH centers were included in the study. The patients were assessed for symptoms in acute phase of SARS-CoV-2 infection and persisting in follow-up visit, WHO functional class, 6-min walk distance, NT-proBNP concentration. The COMPERA 2.0 model was used to calculate 1-year risk of death due to PH at baseline and at follow-up. Sixty-nine patients-54 (77.3%) with PAH and 15 (21.7%) with CTEPH, 68% women, with a median age of 47.5 years (IQR 37-68)-were enrolled in the study. About 17.1% of patients were hospitalized due to COVID-19 but none in an ICU. At follow-up (median: 155 days after onset of SARS-CoV-2 symptoms), 62% of patients reported at least 1 COVID-19-related symptom and 20% at least 5 symptoms. The most frequently reported symptoms were: fatigue (30%), joint pain (23%), muscle pain (17%), nasal congestion (17%), anosmia (13%), insomnia (13%), and dyspnea (12%). Seventy-two percent of PH patients had a low or intermediate-low risk of 1-year death due to PH at baseline, and 68% after COVID-19 at follow-up. Over 60% of PAH/CTEPH patients who survived COVID-19 suffered from long COVID-19 syndrome, but the calculated 1-year risk of death due to PH did not change significantly after surviving mild or moderate COVID-19.
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As the world progressively recovers from the acute stages of the coronavirus disease 2019 (COVID-19) pandemic, we may be facing new challenges regarding the long-term consequences of COVID-19. Accumulating evidence suggests that pulmonary vascular thickening may be specifically associated with COVID-19, implying a potential tropism of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus for the pulmonary vasculature. Genetic alterations that may influence the severity of COVID-19 are similar to genetic drivers of pulmonary arterial hypertension. The pathobiology of the COVID-19-induced pulmonary vasculopathy shares many features (such as medial hypertrophy and smooth muscle cell proliferation) with that of pulmonary arterial hypertension. In addition, the presence of microthrombi in the lung vessels of individuals with COVID-19 during the acute phase, may predispose these subjects to the development of chronic thromboembolic pulmonary hypertension. These similarities raise the intriguing question of whether pulmonary hypertension (PH) may be a long-term sequela of SARS-COV-2 infection. Accumulating evidence indeed support the notion that SARS-COV-2 infection is indeed a risk factor for persistent pulmonary vascular defects and subsequent PH development, and this could become a major public health issue in the future given the large number of individuals infected by SARS-COV-2 worldwide. Long-term studies assessing the risk of developing chronic pulmonary vascular lesions following COVID-19 infection is of great interest for both basic and clinical research and may inform on the best long-term management of survivors.
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Background Current recommendations suggest oxygen (O2) supplementation in patients with pulmonary hypertension (PH). The effect of long-term O2 administration is though merely investigated among these patients. Thus, the aim of this study is to investigate the effect of long term O2 treatment in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) on exercise capacity, clinical parameters and hemodynamics. Methods In this prospective, randomized, controlled trial, 20 patients with PAH or CTEPH under stable PH therapy experiencing O2 desaturations at rest and/or during physical activity will be randomised to receive O2 or standard of care (SoC) for 12 weeks. To patients receiving SoC, O2 therapy will be offered after 12 weeks (cross over design). The primary endpoint is the change of the distance walked in 6 minutes after 12 weeks of treatment. Secondary endpoints include change in clinical parameters and hemodynamics. Results Overall 20 patients (O2 n = 10 vs. SoC n = 10) have already been randomized and 15 have completed the study. Two patients died, one patient due to SARS-CoV2 pneumonia in the oxygen arm and one due to right heart failure in the SoC arm. The O2 therapy is so far well tolerated by all patients. Further results are expected in due course. The study is expected to be completed by the end of December 2022. Conclusion Oxygen therapy is well tolerated. Further results are expected soon. The effect of long-term oxygen supplementation should be furtherly investigated in larger controlled-trials.
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Introduction: Pulmonary hypertension (PH) patients may be vulnerable to SARS-CoV-2 infection, but large analytic studies on morbidity and mortality risks are limited. Aim(s): Assessment of the incidence and course of COVID-19 among patients (pts) diagnosed with PH, treated under the NFZ program, registered in the national BNP-PL database with the assessment of the impact of the SARS-CoV-2 pandemic on the care of patients with pulmonary hypertension in Poland. Method(s): We analyzed the records of the complete population of Polish pts treated under the National Drug Program of PH (PAH and CTEPH), registered in the national database of BNP-PL, and updated on an ongoing basis by all PH centers. The frequency of SARS-CoV-2 infections, clinical severity of COVID-19 course and mortality were reviewed. Clinical characteristics of infected and deceased patients were compared to the remaining patients registered in the BNP-PL database. The rate of increase of new diagnoses ended with inclusion in the Drug Program between 01 March 2020 and 31 August 2021, compared to the pre-pandemic year 2019, and the change in the treatment profile were reviewed. Result(s): The analysis included 1923 pts (PAH 1292, CTEPH 631). The incidence of SARS-CoV-2 infections was 7.4% (n=143) and similar to general population (7.6%), with a slight preponderance in PAH 8.1% (n=105) vs. CTEPH 6.0% (n=38) (p=0.099). 47 patients (33%) required hospitalization. Mortality rate was 24% (34/143) vs. 2.6% for general population - including 19/34 outside of hospital. Those who died due to COVID-19 were older (mean age 56+/-17.6 vs. 70.5+/-12.8 yrs;p<0.0001) and had more cardiovascular comorbidities (1.35 vs. 1.97;p=0.01). Systemic arterial hypertension was the strongest unique risk factor for mortality, present in 71% decedents vs. 45% of survivors, and the only independent risk factor in multivariate logistic regression analysis (OR 2.94, 95% CI 1.28-6.73). Moreover, there was a trend towards a higher incidence of diabetes and coronary artery disease in the group of non-survivors (Table 1). The number of new diagnoses of PH decreased during the pandemic compared to 2019 (new diagnoses rate in 2019 was 28.2/month vs. 19.2/month during COVID). A significant increase in total mortality was also observed in the PH group (11.1/month in 2019 vs. 13.7/month during COVID). Escalation of specific PH therapy also reduced (rate of specific therapy escalation in 2019 was 30.4/month vs. 20.5/month during COVID). Conclusion(s): The COVID-19 pandemic has deeply affected the care of patients with pulmonary hypertension by reducing the number of new diagnoses, escalation of therapy, and increasing overall mortality in this population, and this impact continues into second year of pandemics. Pulmonary hypertension is associated with a more severe course and higher mortality in COVID-19. (Figure Presented).
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BACKGROUND: Preliminary data suggest that the prevalence of pulmonary hypertension (PH) in patients with COVID-19 is around 13%, but its prognostic role remains unclear. Approximately 3% of patients develop chronic thrombo-embolic pulmonary hypertension (CTEPH) following diagnosis of acute pulmonary embolism (PE). It is recommended that patients are screened for CTEPH if they remain symptomatic 3 months following diagnosis of PE. The primary aim of the study was to assess the chances of persistent PH following PE secondary to COVID-19. METHODS: We conducted a retrospective cohort study at a District General Hospital (DGH) in the United Kingdom. All patients diagnosed with COVID-19 and PE between April 2020 and October 2021 were examined. Patients were divided into two groups:·COVID-19 and PE with comorbidities (excluding pre-existing PH) and·COVID-19 and PE without comorbidities. We compared the ECHO features suggestive of PH between the two groups at the time of diagnosis of PE and at 3 months following treatment. RESULTS: 80 patients were included in the study (49 with comorbidities and 31 with no comorbidities). Average age of comorbidities and no comorbidities groups were 73 years and 70 years, respectively. Average PaO2/FiO2 ratio for comorbidities and no comorbidities groups were 170 and 195, respectively. Fourteen patients (13 with comorbidities and 1 with no comorbidities) died in total. Results showed that risk of persistent PH and subsequent mortality following PE in COVID-19 is 4.17 times and 1.32 times more in comorbidity group as compared to no comorbidity group, respectively (p < 0.001). CONCLUSION: Patients with comorbidities are at high risk of persistent PH and mortality due to PE secondary to COVID-19.
Subject(s)
COVID-19 , Hypertension, Pulmonary , Pulmonary Embolism , Humans , Aged , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/complications , Risk Factors , Retrospective Studies , Hospitals, General , COVID-19/complications , COVID-19/epidemiology , Pulmonary Embolism/epidemiology , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Chronic DiseaseABSTRACT
Introduction: Primitive data suggest prevalence of PH in patients with COVID19 is around 13% but prognosis is unclear. Approximately 0.5-2% of patients develop CTEPH after acute PE and recommendation is to screen them for CTEPH if remains symptomatic at 3/12 after PE. Aim(s): The primary aim of the study was to assess the chances of persistent PH following PE secondary to COVID19 Methods: We conducted a retrospective cohort study at a DGH in the UK. All patients diagnosed with COVID-19 and PE between April, 2020 to October, 2021 were examined. Patients were divided into two groups: . COVID19 and PE with co-morbidities(excluding pre existing PH) . COVID19 and PE without co-morbidities We compared the prevalence of pulmonary hypertension between the two groups on cardiac ECHO (defined as a mean pulmonary arterial pressure >= 25mmHg) at the time of diagnosis of PE and at 3 months following treatment. Result(s): 80 patients were included in the study (49 with co-morbidities & 31 with no co-morbidities). Average age of co-morbidities and no comorbidities groups were 73yrs and 70yrs respectively. Average PaO2/FiO2 ratio for comorbidities and no co-morbidities groups were 170 and 195 respectively. 14 patients (13 with co-morbidities & 1 no co-morbidity) died in total. Results showed that relative risk of persistent PH and subsequent mortality following PE in COVID19 is 4.16 times & 1.32 times more in co-morbidties group as compared to no co-morbidties group respectively (p<0.001) Conclusion(s): Patients with co-morbidities are at high risk of persistent PH and mortality due to PE secondary to COVID19 and should be worked up for CTEPH if PH exist on 3/12 ECHO.
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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.
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The COVID-19 (COronaVIrus Disease 2019) caused more than 3.5 million deaths all over the world. Patients who have underlying comorbidity, such as cardiovascular and pulmonary diseases have shown worse prognosis. In view of this, undivided attention was focused on patients with such rare conditions as pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). There is currently limited data available regarding COVID-19 infection in CTEPH patients. The available data are mostly case studies or small case series. The aim of this publication was to describe the course of COVID-19 in patients with previously diagnosed CTEPH. Methods. The study included 92 patients with an established diagnosis of CTEPH, who were managed in the Federal State Budgetary Institution National medical research center of cardiology named after academician E.I.Chazov, Ministry of Health of the Russian Federation. 62 patients with CTEPH and confirmed COVID-19 were enrolled, including 62% women. The mean age was 55.8 +/- 14.8 years. Results. The duration of COVID-19 was 14 [10;30] days. The fever, general weakness, anosmia, and dyspnea were the most frequent presentations at diagnosis of COVID-19 in CTEPH patients. According to the multispiral computed tomography (CT) chest scans, more than half of the patients (54.2%) had mild disease (category CT-1). Most of the patients were under specific therapy (92%), mainly riociguat at an average daily dose of 5.75 +/- 2.2 mg/day. All patients received anticoagulants. No need for long-term respiratory support and no lethal outcomes were registered in the study group. Conclusion. Small pilot studies demonstrated favorable clinical course of COVID-19 in CTEPH patients. This finding could be explained by the protective effect of anticoagulation and specific treatment.Copyright © 2022 Valieva Z.S. et al.
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Introduction: Pulmonary endarterectomy (PEA) is the recommended treatment for patients with operable chronic thromboembolic pulmonary hypertension (CTEPH). Reducing PVR pre-surgery may lower the surgical risk, but efficacy of drug treatment in operable CTEPH has not yet been proven and surgeons are concerned that dissection may be more difficult in pre-treated patients. Methodology: A randomised, double-blind, placebo controlled, multinational prospective study was performed in patients with operable CTEPH and PVR >800 dynes.sec.cm-5 at baseline (NCT03273257). Patients were randomised to Riociguat or placebo for 3 months prior to PEA. Primary endpoint was the change in PVR from baseline to before PEA. Secondary endpoints included perioperative findings and evaluation of the PEA specimen. Planned recruitment was 88 patients over 2 years. Result(s): The study was terminated early because of slow recruitment and the COVID-19 pandemic. At the time of study cessation, 14 patients were randomised (7 in each group) and 11 patients completed PEA surgery. At diagnosis, PVR was 944.0 dynes.sec.cm-5 in the Riociguat group and 1007.5 dynes.sec.cm-5 in the control group. -5 -5 The mean change in PVR prior to PEA was -28.4% for Riociguat and -6.9% for placebo (p=0.14). Completeness of surgical clearance was as expected in all patients. In the Riociguat group ease of dissection plane was rated as easier in 1, normal in 3 and more difficult in 2. In the control group, it was rated as easier in 1 and normal in 4. There were no surgical complications or post-operative deaths and no new safety signals. Conclusion(s): Due to the premature study discontinuation and the limited sample size, we are unable to determine the impact of bridging therapy on PEA outcomes.
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The COVID-19 (COronaVIrus Disease 2019) caused more than 3.5 million deaths all over the world. Patients who have underlying comorbidity, such as cardiovascular and pulmonary diseases have shown worse prognosis. In view of this, undivided attention was focused on patients with such rare conditions as pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). There is currently limited data available regarding COVID-19 infection in CTEPH patients. The available data are mostly case studies or small case series. The aim of this publication was to describe the course of COVID-19 in patients with previously diagnosed CTEPH. Methods. The study included 92 patients with an established diagnosis of CTEPH, who were managed in the Federal State Budgetary Institution National medical research center of cardiology named after academician E.I.Chazov, Ministry of Health of the Russian Federation. 62 patients with CTEPH and confirmed COVID-19 were enrolled, including 62% women. The mean age was 55.8 ± 14.8 years. Results. The duration of COVID-19 was 14 [10;30] days. The fever, general weakness, anosmia, and dyspnea were the most frequent presentations at diagnosis of COVID-19 in CTEPH patients. According to the multispiral computed tomography (CT) chest scans, more than half of the patients (54.2%) had mild disease (category CT-1). Most of the patients were under specific therapy (92%), mainly riociguat at an average daily dose of 5.75 ± 2.2 mg/day. All patients received anticoagulants. No need for long-term respiratory support and no lethal outcomes were registered in the study group. Conclusion. Small pilot studies demonstrated favorable clinical course of COVID-19 in CTEPH patients. This finding could be explained by the protective effect of anticoagulation and specific treatment.
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PURPOSE: To evaluate the clinical outcome of Q-SPECT/CT in pulmonary thromboembolic disease. METHODS: From Jan 2020 to Jan 2021, 30 consecutive patients (M:F = 8:22; median age = 52 year (21-89)) suspected of having acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH) were referred for non-contrasted Q-SPECT/CT. All patients were COVID-19 PCR negative. MSKCC Q-SPECT/CT and/or PISAPED criteria were used to determine the presence of thromboembolic disease in Q-SPECT/CT. Final diagnosis was made based on composite reference standards that included at least 2-month clinical cardiorespiratory assessment and follow-up imaging. RESULTS: Q-SPECT/CT was positive in 19 patients: indeterminate in 1 and 10 were negative. Three false positive cases were observed during follow-up. Of the remaining 16 true positives, all patients' cardiorespiratory symptom were improved or stabilised after treatment with anticoagulants. The overall sensitivity, specificity, PPV, NPV and accuracy of Q-SPECT/CT were 100% (95% CI, 79.41-100%), 78.57% (95% CI, 49.20-95.34%), 84.21% (95% CI, 66.41-93.57%), 100% and 90.00% (95% CI, 73.47-97.89%) respectively. CONCLUSIONS: In the current COVID-19 pandemic, Q-SPECT/CT can be an alternative modality to detect pulmonary thromboembolic disease. Normal Q-SPECT/CT excludes pulmonary thromboembolic disease with high degree of certainty. However, false positive has been observed.
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Pulmonary hypertension (PH) is a severe disease that can progress to clinical decompensation, risk of hospitalization and death owing to disease-related or other diseases. In the context of coronavirus disease 2019 (COVID-19), PH was considered a risk factor for complications. The purpose of the study was to assess the mortality rate of COVID-19 in PH patients from a PH Center in Brazil. We conducted a telephone survey between June and August 2021 among all patients or relatives from the PH referral center who were followed after the first case of COVID- 19 in Brazil. Only patients with a confirmed diagnosis of PH were included in the analysis. Of the 426 patients followed in the first 18 months of the pandemic, 115 patients were excluded (lost to follow-up, post-acute PE or unconfirmed PH). Among 311 patients included, 39 had a confirmed diagnosis of COVID-19 (COVID-19 + ), and 38.5% of patients were hospitalized. The estimated incidence rate was 12.5%. Comparing the COVID-19+ versus patients without infection (COVID-19 - ) in the period, the mean age was similar (55 +/- 17 vs. 54 +/- 16 years) and the majority in the COVID-19+ group were female (85% vs. 69%, p = 0.039), respectively. There was no difference in the proportion of patients diagnosed with pulmonary arterial hypertension (PAH;49% and 42%) and chronic thromboembolic pulmonary hypertension (CTEPH;24% and 33%) between groups. All PAH patients and the majority of CTEPH patients were treated on specific therapy (combination/triple therapy, 70%). The case fatality rate in the PH-COVID-19+ group was 23%. Considering only PAH and CTEPH, the case fatality rate was 21,9%, while COVID-19 mortality was 2.9% and overall lethality in Brazil was 2.8%. In the COVID-19+ group, the mean pulmonary artery pressure was 48 +/- 14 mmHg, cardiac index 2.7 +/- 0.6 L/min/m2 and pulmonary vascular resistance 730 +/- 424 dyn.s/cm5. In conclusion, among PH patients there was high incidence and mortality from COVID-19, even in those with PHspecific therapy. Further studies are needed to evaluate the prognostic predictors in PH-COVID-19 patients.
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On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.
Subject(s)
COVID-19 , Hypertension, Pulmonary , Pulmonary Embolism , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Chronic Disease , COVID-19/complications , Pulmonary Embolism/diagnosis , Pulmonary Embolism/complications , EchocardiographyABSTRACT
Aim/Introduction: Covid virosis can cause different injuries of lung parenchyma and vasculature. Viral pneumonia is considered to be a possible precursor to pulmonary fibrosis. There is also a risk for thromboembolism and in-situ thrombotic microangiopathy. V/Q pulmonary scintigraphy is an established procedure to detect acute as well as chronic thromboembolism including prognosis of chronic thromboembolic pulmonary hypertension, but it is not able to assess lung interstitium. The goal of our study was to assess possible pathology in patients sent to our department for lung scintigraphy after Covid-19 virosis. Material(s) and Method(s): We evaluated 27 patients, 15 female and 12 male, average age of 56 (34 to 85) year. All suffered Covid-19 virosis and was sent to exclude pulmonary embolism. The average time after virosis was 3 (0 to 8) months, 2 patients were actually ill. Clinical symptoms included resting or exertional dyspnea or chest pain. Several patients had increased D-dimer or signs of pulmonary hypertension on echocardiography. We performed V/Q pulmonary scintigraphy (99mTc MAA and 81mKr) on a dual head gamma camera together with a nondiagnostic low dose CT. We evaluated changes of perfusion in relation to embolism and parenchymal changes on CT portion of examination (increased or decreased density of parenchyma, effusion or combination). Result(s): No patient had typical signs of pulmonary embolism (V/Q mismatch). We detected no pathology in 10 patients. 9 patients had increased density of lung parenchyma consistent with fibrosis. It demonstrates the interstitial nature of lung damage from viral pneumonia, which can be expected in patients after Covid-19 pneumonia. 9 patients had decreased density of lung parenchyma consistent with emphysema and 3 patients had an effusion. 3 patients had fibrotic changes together with effusion, one patient had both fibrotic and emphysematous changes. Conclusion(s): Although the V/Q pulmonary scintigraphy is an established procedure to assess pulmonary embolism, it is, in principle, not able to assess lung parenchyma. This gap can be overcome by combination with a low-dose CT, which is especially useful in patients suffered Covid-19 virosis.
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Aim/Introduction: Airborne infections are particularly challenging for in-patient care units. In general, hospitals take more precautions to prevent airborne spread of diseases and several guidelines recommend expiratory filters during nebulizer therapies to reduce exhaled bioaerosols. However, a substantial reduction of virusloaded aerosols depend on a high filter performance for particles 100 -500nm in size. This study aimed to test the effectiveness of filter pads in the reduction of exhaled aerosols by applying 99mTclabeled graphite aerosol. Material(s) and Method(s): In 37 patients with suspected pulmonary embolism or CTEPH an inhalation scintigraphy was performed with 99mTc-labeled graphite aerosol (Technegas ©, particle size 30 -60nm ). The exhalate was filtered by a PARI filter/valve set equipped with a PARI filter pad and then collected in a plastic bag reservoir. Count rates of the filter pads and reservoirs were estimated by planar imaging within a SPECT/ CT. In addition, the individual volumes of the exhaled air were determined. The percentage filter efficacy of the filter pads was calculated. Finally, correlational statistics (Spearman's correlation) addressing the following interactions were performed: (1) exhalate volume and count rates of the filter pads, (2) filter pads' count rates and filter retention efficacy, and (3) exhaled breath volume and filter retention efficacy. Result(s): Mean count rates of the filter pads and the reservoirs containing the filtered exhalate were 26023 +/- 8327 cts/s and 169 +/- 153 cts/s, respectively. The efficacy of the PARI filter/ valve set with PARI filter pad was 98.5 +/- 0.9% (range 96.2 -99.7%). The mean exhaled volume was 9.5 +/- 4.6 l (range 2.4 -21.0 l). The exhalate volumes positively correlate with the filter pad count rates (p=0.006) which, in turn, negatively correlate with the filter pad efficacy (p=0.04). However, an inter-relation of exhaled breath volume and filter pad efficacy failed to reach significance (p=0.07). Conclusion(s): The filter pad of the PARI filter/valve set demonstrated a high retention rate of aerosol particles < 100nm in size. Therefore, in patients suffering from respiratory infections these filter pads used in expiratory filters are suitable to substantially reduce airborne virus load, e.g. COVID-19 SARS CoV2, in their exhalates. Additionally, we found evidence that the filter retention efficacy decreased with increased filter particle load indicating a need for regular filter changes.
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Aim/Introduction: Pulmonary emboli (PE) have conventionally been reported in a binary fashion without quantification. Following development and phantom validation of a Pulmonary Parenchymal Burden (PPB) quantification method to measure the percentage of lung parenchyma affected by PE, we wanted to explore whether the %PPB is clinically pertinent, specifically whether it correlates with the development of long term sequelae and so may be helpful in outcome prediction and triaging patients to different management pathways. Material(s) and Method(s): : A retrospective single centre study carried out on patients scanned before the COVID pandemic. Patients with pre-existing cardiorespiratory disease were excluded. 40 patients who had PE and had undergone V/Q SPECT between January 2018- May 2020 with documented clinical follow up of >20 months were included. All patients had undergone simultaneous V/Q SPECT with 81mKr, 99mTc-MAA according to the departmental clinical protocol. Images were reconstructed according to a prevalidated V/Q quantification optimised protocol and PEs were quantified using a SPECT viewing platform with volumetric quantification. %PPB was calculated as the total parenchymal PE volume divided by the total lung ventilation volume. Clinical outcome was assessed using NHS trust electronic clinical documentation. Note was made of presence or absence of 2 parameters: persistent dyspnoea/impaired exercise tolerance (DIETT) with 3 months of anti coagulation and presence or absence of chronic thromboembolic pulmonary hypertension (CTEPH). Statistical analysis was performed by Graphpad prism 9.3.1 version for windows. Result(s): :21 females and 19 males with a mean age of 45.2(range 19-72years). There was a statistically significant difference in %PPB with the presence or absence of DIETT (mean%PPB:34.5%, standard deviation (SD):18.92 vs mean%PPB:10.81%, SD:14.03%;t-test p=0.001). There was a statistically significant difference in %PPB with the presence or absence of CTEPH (mean%PPB:51%, SD= 10.12 vs mean PPB = 20.76, SD: 17.4% ;t-test p=0.0002). Conclusion(s): In patients with known persistent PE, %PPB can discriminate long term sequelae of DIETT and CTEPH following PE. A quantitative %PPB tool may therefore be a useful addition to standard imaging to help triage patients into different clinical management groups.
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Aim/Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a difficult entity to diagnose due to its association with other etiologies causing pulmonary hypertension (PHT), mainly cardiological disease. Our aim is to analyse the value of pulmonary perfusion SPECT/CT in the presence of suspected CTEPH and to evaluate its impact on the diagnosis and subsequent therapeutic approach. Material(s) and Method(s): Retrospective series of 108 patients with suspected CTEPH who were performed a lung perfusion SPECT/CT in the presence of perfusion defects on planar images between March 2020-April 2022. Variables such as age, sex, scintigraphic result, other radiological findings, correlation with catheterisation and CT angiography, type of PHT (according to Dana Point Consensus Classification of Pulmonary Hypertension, California 2008) and therapy of choice after scintigraphy were analysed. Result(s): Mean age: 69 +/- 12 years (25-90). 54% women. In 55 patients(51%) CTEPH was ruled out by SPECT/CT(-), although other radiological findings were observed (13% chronic parenchymal pathology/post-COVID-19 infection, 7% cardiomegaly, 5% pleural effusion, 4% infiltrates consistent with COVID-19 infection,2% pulmonary nodule suspicious of malignancy). 6 of the 18 patients with catheterisation(33%) had a pulmonary capillary pressure(PCP) suspicious for CTEPH(<=15mmHg), which was ruled out after negative scintigraphy. In the 53(49%) confirmed CTEPH by SPECT/ CT(+), 28 with other radiological findings(36% chronic pulmonary pathology/post-COVID-19,11% pulmonary nodule suspicious of malignancy,11% infiltrates consistent with COVID-19 infection). 10 of 15 patients(67%) with CT angiography(-). 55% of the patients with catheterisation(11/20) presented with a PCP not suspicious of CTEPH(>=15mmHg), and were finally diagnosed with CTEPH after positive SPECT. In patients without CTEPH after SPECT(-), PHT was classified into the following types:37 with PHT type-II/left heart disease(6 candidates for valve replacement),9 type-III/pulmonary disease and/or hypoxaemia, 5 mixed type-II+III, 2 type-I (1 portal hypertension in cirrhotic patient and 1 scleroderma), 2 type-V (1 obstruction of tumour origin and 1 chronic renal failure). of the patients who were confirmed to have CTEPH, 19(36%) had purely embolic PHT(type-IV), with 5 being candidates for endacterectomy/ angioplasty, and the remaining 34(64%) had mixed PHT(24 type-II+IV, 5 type-III+IV, 5 type-II+III+IV), with 35% being candidates for surgery. Conclusion(s): Lung perfusion SPECT/CT imaging is a very useful test for the classification of pulmonary hypertension leading to better therapeutic management of these patients. The greatest efficiency is seen with a negative result as the embolic origin is excluded with excellent reliability, thus avoiding more aggressive and/or difficult-to-manage therapies. In addition, low-dose CT provides additional information of great clinical relevance.
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Current recommendations suggest oxygen (O2) supplementation in patients with pulmonary hypertension (PH). The effect of long-term O2 administration has not been investigated much among these patients. Thus, the aim of this study is to investigate the effect of long term O2- treatment in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) on exercise capacity, clinical parameters and hemodynamics. In this prospective, randomized, controlled trial, 20 patients with PAH or CTEPH under stable PH therapy experiencing oxygen desaturations at rest and/or during physical activity will be randomized to receive oxygen or standard of care (SoC) for 12 weeks. To patients receiving SoC, O2 therapy will be offered after 12 weeks (cross-over design). The primary endpoint is the change in the distance walked in 6min after 12 weeks of treatment. Secondary endpoints include change in clinical parameters and hemodynamics. Overall, 20 patients (O2 n=10 vs. SoC n=10) are planned to participate. So far, 12 patients have already been randomized and nine have completed the study. Two patients died, one patient owing to SARS-CoV2 pneumonia in the oxygen arm and one owing to right heart failure in the SoC arm. So far, the O2 therapy is being well tolerated by all patients. Further results are expected in due course. The study is expected to complete recruitment by the end of September 2022. Oxygen therapy is well tolerated. Further results are expected soon. The effect of long-term oxygen supplementation should be investigated further in larger controlled trials.
ABSTRACT
Assessing small airway functional impairment, therapeutic response and disease progression in patients with pulmonary vascular and/or interstitial lung disease (ILD) continues to be challenging. Hyperpolarized Xenon (Xe) MRI enables noninvasive evaluation and regional quantification of alveolar gas exchange via three-dimensional mapping of ventilation, interstitial membrane uptake and red blood cell transfer. This global, open-label, multicenter study will implement harmonized methodology to evaluate safety and tolerability of hyperpolarized Xe gas in patients with pulmonary hypertension and ILD. Adult patients (n=200) with pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, idiopathic pulmonary fibrosis or ILD-associated systemic sclerosis (SSc-ILD) will be enrolled and undergo Xe MRI for evaluation of treatment response and comparison with standard-of-care diagnostic measurements. Eligible patients will be initiating/changing therapy or undergoing a disease-specific procedure. An exploratory cohort (n=50) will allow Xe MRI in patients with long-COVID, unexplained dyspnea, possible transplant (lung or stem cell) rejection, World Health Organization group 3 pulmonary hypertension or other ILDs. Healthy volunteers (n=50) will be enrolled to evaluate Xe MRI reproducibility. Changes in Xe MRI (within patient groups) at 1, 3, 6 and 12 months;Cross-sectional and longitudinal relationships of Xe MRI with spirometry, including diffusing capacity of carbon monoxide (DLCO);Xe MRI measurements compared with right heart catheterization (RHC) and echocardiogram [PH patients] and computed tomography (CT) [ILD patients]. Relationship of Xe MRI quantitative measures across compartments (air/tissue/blood) to treatment response;Changes in Xe MRI parameters to assess temporal relationship to changes in standard diagnostics, healthcare utilization, quality-of-life andmorbidity/mortality;Relationship of Xe MRI cardiogenic oscillation signals of pulmonary-vascular hemodynamics with RHC and clinical outcomes. Patients will begin enrollment within the USA in mid-2022. All patients will participate for at least 1 year (and up to 3 years). Interim analyses will be conducted yearly, with additional snapshots periodically.
ABSTRACT
Few reports on coronavirus disease 2019 (COVID-19) infection in patients with group 1 or group 4 pulmonary hypertension (PH) have been published, with a discrepancy in the incidence of the disease in this rare and heterogeneous population and also differences in the reported outcomes, such as hospitalization and mortality rates. The aim was to describe the case incidence of COVID-19 among Greek PH expert centers. A total of nine PH expert centers participated in this report, cumulatively caring for 499 PH patients [372 patients with pulmonary arterial hypertension (PAH) and 127 patients with chronic thromboembolic pulmonary hypertension (CTEPH)] according to recent data retrieved from the prospective HOPE Registry and personal communication with the expert centers, to record RTPCR- confirmed COVID-19 cases. Eighteen cases of COVID-19 (12 PAH and six CTEPH) were reported from the end of February 2020 to 14 August 2021, contributing to an estimated incidence of 36.1 (95% confidence interval 21.5-56.4) COVID-19 cases in 1,000 patients with group 1 and 4 PH. The median age of affected patients was 54.5 years (range 25-86 years), and 77.8% were women. All patients reported a symptomatic course of COVID-19 [median duration 6 days (range 2-30 days)]. No case of incident venous thromboembolism was described. All patients resumed PAH-targeted therapies during the course of the infection. Eight (44.4%) patients were hospitalized, and four (22.2%) died. Three of them were >=70 years of age, and the other had significant comorbidities. The remaining four were discharged after a median of 11 days (range 8-30 days). Recovered patients do not report deterioration of their functional status after COVID-19 infection, nor persistent symptoms. There is increased severity of COVID-19 among PAH and CTEPH patients, mainly owing to the increased age and comorbidities of the patients. Strong medical advice should be offered to all PH group 1 and 4 patients to be vaccinated and continue to adhere to preventive infection measures.