Acute pulmonary hypertension in critically ill patients with COVID-19 was associated with signs of cardiac failure and increased mortality, according to the results of a recent study published in the journal Acta Anaesthesiologica Scandinavica.

Researchers retrospectively reviewed medical records from patients with COVID-19 treated in the intensive care unit (ICU). Outcomes from patients with the occurrence of acute pulmonary hypertension as per established transthoracic echocardiography were compared with those without acute pulmonary hypertension. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T were measured as markers of cardiac failure and myocardial injury.

Among the 67 patients treated in the ICU, 26 had a systolic pulmonary artery pressure higher (sPAP) than 35 mm Hg, meeting the definition of acute pulmonary hypertension. NT-proBNP and troponin T levels were elevated in the acute pulmonary hypertension group, showing increased levels of myocardial injury and cardiac failure. Additionally, the 21-day mortality rate was also substantially higher in patients with acute pulmonary hypertension compared with patients not meeting the diagnostic criteria (46% vs 7%, respectively).


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“[W]hen using an accepted echocardiographic definition of elevated systolic pulmonary arterial pressure (ie, estimated sPAP >35 mm Hg), approximately 40% of COVID-19 patients admitted to ICU care at our hospital met the criteria for acute pulmonary hypertension,” the study authors wrote. “The presence of acute pulmonary hypertension was also associated with high NT-proBNP values (indicating cardiac failure) and troponin T values (indicating myocardial injury), as well as a 7-fold increase of 21-day mortality compared to patients without acute pulmonary hypertension.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Norderfeldt J, Liliequist A, Frostell C, et al. Acute pulmonary hypertension and short-term outcomes in severe Covid-19 patients needing intensive care. Acta Anaesthesiol Scand. Published online March 16, 2021. doi:10.1111/aas.13819