An updat‎e on Pulmonary Hypertension in Coronavirus Disease-19 (COVID-19)

Coronavirus 19 disease (COVID-19) continues to be a pandemic with global implications. Res-piratory system involvement is the most common manifestation in symptomatic patients. In this literature review, we describe the diagnosis, management, and implications of pulmonary hypertension (PH) among patients with COVID-19. We defined pulmonary hypertension as increasing mean pulmonary artery pres-sure (mPAP) of ≥ 25 mm Hg at rest. In our literature search, we identified 4 articles with details on pulmo-nary hypertension. Among these, two reported various echocardiographic details for diagnosing pulmonary hypertension. In 1 study evidence of pulmonary hypertension was noted in 13.4% of patients. Patients with severe COVID-19 were reported to have a higher proportion of pulmonary hypertension as compared to mild COVID-19 disease [22% vs 2%]. Elevated pulmonary artery systolic pressure was significant in pre-dicting mortality. COVID-19 patients with chronic obstructive pulmonary disease, congestive heart failure, myocardial injury, pulmonary embolism, and prior pulmonary hypertension were at a higher risk of worsen-ing pulmonary hypertension. Multiple mechanisms for developing pulmonary hypertension that have been postulated are i) concomitant worsening myocardial injury, ii) cytokine storm, endothelial injury, hyperco-agulability attributing to development of venous thromboembolism, iii) and the presence of thrombotic mi-croangiopathy. Among patients with severe COVID-19 disease and pulmonary hypertension, complications including acute respiratory distress syndrome, acute myocardial injury, the requirement of intensive care unit admission, the requirement of mechanical ventilation, and mortality are higher. (www.actabiomedica.it)