MANAGEMENT OF PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION IN THE PANDEMIC OF A NEW CORONAVIRUS INFECTION
https://doi.org/10.38109/2225-1685-2020-2-54-60
Abstract
The pandemic of a new coronavirus infection – COVID-19 («Coronavirus disease 2019») has changed the routine management of patients with pulmonary arterial hypertension (PAH). Like patients with other chronic cardiovascular diseases, PAH patients are not at higher risk of a new coronavirus infection. However, in the current epidemiological situation, the problems of managing high-risk groups are sharply indicated, in which the severe course of COVID-19 with a higher lethality is more often noted. Undoubtedly, рatients with different forms of pulmonary hypertension belong to the high-risk group, considering both the presence of severe lifethreatening cardiovascular pathology and background pathology in cases of the associated forms of the disease.
At the same time, the first foreign experience indicates a rather low incidence and relatively favorable course of COVID-19 in PAH, which allows to formulate a number of hypotheses that will be confirmed or rejected in the near future. The unique problems of managing patients with PAH are those associated with changes in generally accepted standards of medical care and patient routing, which is especially important for patients receiving PAH-specific drugs. The problems of a complex assessment of the risk of possible infection in the event of hospitalization or an outpatient visit of patients on the one hand, and on the other, the risk of PAH progression with a delay in starting treatment, are a dilemma that requires an individual solution. Based on an analysis of current data, this review summarizes the main approaches to managing patients with PAH in the current epidemiological situation.
About the Authors
T. V. MartynyukRussian Federation
Tamila V. Martynyuk, Dr. of Sci. (Med.), Head of the Department of Pulmonary Hypertension and Heart Diseases
Professor, Department of Cardiology, Faculty of Continuing Professional Education
A. M. Aleevskaya
Russian Federation
Anna M. Aleevskaya, laboratory assistant researcher at the Department of Pulmonary Hypertension and Heart Diseases
O. V. Rodnenkov
Russian Federation
Oleg V. Rodnenkov, Cand. of Sci. (Med.), senior researcher of the department of pulmonary hypertension and heart diseases
A. V. Zorin
Russian Federation
Andrey V. Zorin, Cand. of Sci. (Med.), researcher at the department of pulmonary hypertension and heart diseases
A. M. Kasparova
Russian Federation
Anna M. Kasparova, cardiologist of the 2nd clinical department, department of pulmonary hypertension and heart diseases
S. N. Nakonechnikov
Russian Federation
Sergey N. Nakonechnikov, Dr. of Sci. (Med.), professor, Department of Cardiology, Faculty of Continuing Professional Education
Director
I. E. Chazova
Russian Federation
Irina Ye. Chazova, Academician of the Russian Academy of Sciences, Professor, Dr. of Sci. (Med.), Deputy Director General for Research and expert work, Head of the Department of Hypertension
References
1. https://scardio.ru/content/Guidelines/COVID-19.pdf Guidelines for the diagnosis and treatment of circulatory system diseases (BSC) in the context of the COVID-19 pandemic (in Russ.)
2. https://www.who.int/dg/speeches/detail/whodirector-general-s-openingremarks-at-the-media-briefing-on-covid-19---11-march-2020.
3. Eurasian clinical guidelines on diagnosis and treatment of pulmonary hypertension. Eurasian heart journal. 2020;(1):78-122. (In Russ.) doi:10.24411/2076-4766-2020-10002.
4. Ryan J.J., Melendres L., Zamanian R.T., et al. Care of patients with Pulmonary Arterial Hypertension during the Coronavirus (COVID-19) Pandemic. DOI: 10.1177/2045894020920153.
5. Temporary guidelines “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)” Version 6. (In Russ.) https://static-1.rosminzdrav.ru/system/attachments/attaches/000/049/986/original/09042020_%D0%9C%D0%A0_COVID-19_v5.pdf
6. Ling Y, Johnson MK, Kiely DG, et al. Changing demographics, epidemiology, and survival of incident pulmonary arterial hypertension: results from the pulmonary hypertension registry of the United Kingdom and Ireland. Am J Respir Crit Care Med. 2012; 186(8): 790-6.
7. Hoeper M.M., McLaughlin V.V., et al. Treatment of pulmonary hypertension. LancetRespir Med, 2016; 4: 323-36.
8. Horn E.M., Rosenzweig E.B. Could pulmonary arterial hypertension (PAH) patients be at a lower risk from severe COVID-19? Mar 5; [e-pub]. DOI: 10.1177/2045894020922799.
9. Teijaro J.R., Walsh K.B., Cahalan S., et al. Endothelial cells are central orchestrators of cytokine amplification during influenza virus infection. Cell. 2011; 146 (6):980-91.
10. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020 Mar 5; [e-pub].
11. Wenzel R.R., Ruethemann J., Bruck H., et al. Endothelin-A receptor antagonist inhibits angiotensin II and noradrenaline in man. Br J Clin Pharmacol, 2001. 52: 151-157.
12. Cozzi E., Calabrese F., et al. Immediate and catastrophic antibodymediated rejection in a lung transplant recipient with anti-angiotensin II receptor type 1 and Anti-endothelin-1 Receptor type A antibodies. Am J of Transplantation 2017; 17: 557-564.
13. Frost A.E., Badesch D.B., Miller D.P., et al. Evaluation of a predictive value of a clinical worsening definition using 2-Year outcomes in patients with pulmonary arterial hypertension. A REVEAL Registry Analysis. Chest 2013; 144(5):1521-9.
14. McLaughlin V.V., Hoeper M.M., Channick R.N., et al. Pulmonary Arterial Hypertension-Related Morbidity Is Prognostic for Mortality. J Am Coll Cardiol. 2018; 71(7):752-63.
15. Martynuk T.V., Nakonechnikov S.N., Chazova I.Ye. Macitentan: the evolution of the class endothelin receptor antagonists to improve efficacy and safety of PAH treatment. Eurasian heart journal. 2013;(2):15-26. (In Russ.)
16. Ilyin N.V., Ivanov K.I., Martynyuk T.V. New treatment options for pulmonary arterial hypertension – the first selective ip-receptor agonist selexipag. Cardiovascular therapy and prevention 2019; 18 (6): 80-87 (In Russ.).
17. Sztrymf B, Souza R, Bertoletti I, et al. Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension. Eur Respir J 2010; 35: 1286–1293.
18. Zamanian R.T., Haddad F., Doyle R.L., Weinacker A.B. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med 2007; 35:2037–2050.
19. Price LC, Wort SJ. Pulmonary hypertension in ARDS: inflammation matters! Thorax 2017; 72(5):396-7.
20. Ryan J.J., Butrous G., Maron BA. The heterogeneity of clinical practice patterns among an international cohort of pulmonary arterial hypertension experts. Pulm Circ. 2014 4(3):441-51.
21. Hoeper M.M., Benza R.L., Corris P., et al. Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension. Eur Respir J. 2019; 53(1):1-12.
22. Rosenzweig E.B., Brodie D., Abrams D.C., et al. Extracorporeal membrane oxygenation as a novel bridging strategy for acute right heart failure in group 1 pulmonary arterial hypertension. ASAIO J 2014; 60: 129–133.
Review
For citations:
Martynyuk T.V., Aleevskaya A.M., Rodnenkov O.V., Zorin A.V., Kasparova A.M., Nakonechnikov S.N., Chazova I.E. MANAGEMENT OF PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION IN THE PANDEMIC OF A NEW CORONAVIRUS INFECTION. Eurasian heart journal. 2020;(2):54-60. (In Russ.) https://doi.org/10.38109/2225-1685-2020-2-54-60