Cardiovascular status and echocardiographic changes in survivors of COVID-19 pneumonia three months after hospital discharge

Coronavirus disease 2019 (COVID-19) affects the function of all organs and systems. Today, studying the effect of COVID-19 on cardiovascular system, including on echocardiographic characteristics, is relevant.Aim. To study the prevalence of symptoms, cardiovascular disease and changes in echocardiographic data in persons after documented COVID-19 pneumonia 3 months after discharge from the hospital.Material and methods. The study included 106 patients after documented COVID-19 pneumonia. The patients underwent a comprehensive examination during hospitalization and 3 months±2 weeks after discharge from the hospital. The mean age of participants was 47±16 years (19-84 years); 49% of subjects were women.Results. Three months after hospital discharge, the symptoms persisted in 86% of examined patients. There were significant echocardiographic changes as follows: a decrease in LV end-diastolic, end-systolic and stroke volume (113,8±26,8 ml vs 93,5±29,4 ml; 37,7±13,0 ml vs 31,3±14,2 ml; 77,2±17,8 ml vs 62,2±18,7 ml, respectively, p<0,001 for all). The right ventricular anteroposterior dimension and the pulmonary trunk diameter decreased over time (26,0 [24,0-29,3] mm vs 25,0 [23,0-27,0] mm, p=0,004; 21,7±3,6 mm vs 18,7±2,5 mm, p<0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] m><0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] ml vs 31,0 [22,0-36,5] ml, p<0,001) a><0,001) and maximum width (36,1±4,6 mm vs 34,5±6,5 mm, p=0,023) decreased, while the right atrial maximum length increased (46,7±6,8 mm vs 48,6±7,1 mm, p=0,021).Conclusion. In survivors of COVID-19 pneumonia three months after hospital discharge, complaints persisted in 86% of cases. Cardiovascular diseases were detected in 52% of participants, including hypertension in 48,1% and coronary artery disease in 15,1%. Compared with in-hospital data, the echocardiographic characteristics improved, which was expressed mainly in a decrease in right heart load

Echocardiographic characteristics of COVID-19 pneumonia survivors three months after hospital discharge

Coronavirus disease 2019 (COVID-19) is an infectious disease that affects almost all organs and systems. The main target is the respiratory system, but cardiovascular involvement is also common. Today, it is relevant to study the effect of complicated COVID-19 course on the patient’s cardiovascular system after hospital discharge — in particular, echocardiographic parameters.Aim. To study the echocardiographic parameters of patients with COVID-19 pneumonia 3 months after discharge from the hospital.Material and methods. The study included 106 patients with documented COVID-19 pneumonia. Patients underwent a comprehensive examination during hospitalization and 3 months ± 2 weeks after hospital discharge. The mean age of participants was 47±16 years (from 19 to 84 years), while 49% were women.Results. Three months after discharge, the average body mass index of the subjects was 28,2±5,7 kg/m2. Obesity was noted in 37,1%, cardiovascular diseases — in 52%. According to echocardiography, the prevalence of right ventricular (RV) dilatation was 2,9%, a decrease in tricuspid annular plane systolic excursion (TAPSE) — 9,5%, grade ≥2 tricuspid regurgitation — 1,9%, pulmonary hypertension (pulmonary artery systolic pressure >36 mm Hg) — 3,8%. The mean value of RV global longitudinal myocardial strain (GLMS RV) and global longitudinal myocardial strain (GLES RV) was 19,6±4,5 and 20,6±4,6, respectively. We found moderate correlations between GLMS RV and blood flow time through the left ventricular outflow tract (OT) (r=-0,436), through the mitral valve (r=-0,390; both p<0,0001) and through the RVOT (r=-0,348; р=0,004), with cardiac index (CI) (r=0,316; p=0,009), as well as between GLES RV and blood flow time through the LVOT (r=-0,411; p<0,0001) and RVOT (r=-0,300; p=0,005), and with CI (r=0,302; p=0,004). At the same time, the correlation of GLES RV with RV fractional area change (FAC) was weak (r=-0,283; p=0,007), while there was no correlation with the TAPSE. In addition, correlation of GLMS RV with these parameters were not defined.Conclusion. Three months after COVID-19 pneumonia, RV strain parameters were shown to have stronger relationships with time characteristics of flows in LVOT and RVOT, as well as with CI, than with such generally accepted characteristics of RV function as FAC and TAPSE

Algorithm for cancelling inhaled corticosteroids in patients with chronic obstructive pulmonary disease. Regional Meeting of Experts

A treatment algorithm for chronic obstructive pulmonary disease (COPD) implies that all patients with COPD should receive long-acting anticholinergic bronchodilators, long-acting β2 -agonists, or a combination of these drugs as the basic therapy. Inhaled corticosteroids (IHCs) are indicated for a limited group of patients with COPD and have a number of contraindications. Clear indications for the IHCs use as dual therapy in combination with long-acting β2 -agonists, or as triple therapy in addition to long-acting anticholinergic bronchodilators combination, were determined. IHCs in combination with long-acting bronchodilators are prescribed for patients with COPD in cases of non- infectious exacerbations recurring during the year in frames of treatment with long-acting bronchodilators with anamnestic indications or the presence of bronchial asthma and/or the eosinophil number in the blood test without exacerbation >300 cells/μl. Algorithm for IHC cancellation has been developed for patients with COPD due to several causes: complications development as a result of IHC prolonged treatment; evidence of the benefits or equivalent effects of long-acting bronchodilators compared to inhaled corticosteroid-containing therapy.Алгоритм лечения хронической обструктивной болезни легких (ХОБЛ) подразумевает, что все пациенты с ХОБЛ должны получать длительнодействующие антихолинергические бронходилататоры (ДДАХ), длительнодействующие β2 -агонисты (ДДБА) либо сочетания этих препаратов в качестве базисной терапии. Ингаляционные глюкокортикостероиды (ИГКС) показаны ограниченной группе пациентов с ХОБЛ и имеют ряд противопоказаний. Определены четкие показания к применению ИГКС в качестве двойной терапии в сочетании с ДДБА либо тройной терапии дополнительно в сочетании с ДДАХ. ИГКС в сочетании с ДДБД назначаются больным с ХОБЛ в случаях повторяющихся в течение года неинфекционных обострениях на фоне лечения ДДБД при анамнестических указаниях или наличии бронхиальной астмы и/или количестве эозинофилов крови вне обострения >300 кл./мкл. Разработан алгоритм отмены ИГКС у пациентов с ХОБЛ в связи с развитием осложнений в результате длительной терапии ИГКС и наличием доказательств преимущества или равнозначного эффекта ДДБД в сравнении с ИГКС-терапией