24 March 2021
Marion Delcroix, University Hospitals of Leuven, Belgium
Sylvia Cohen-Kaminsky, Université Paris Saclay, France
Please note that the recording of this event is only available to members. All PVRI2021 webinars will be made public up to 12 weeks after the event date. Please sign up for news on the sidebar of this page to be alerted when this recording will be made available to non-members.
A year ago, WHO declared COVID 19 a global pandemic. The causative agent was identified as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and since then, the international scientific community focused on the fight against this disease. The infection from the virus displays clinical and pathophysiological features that have not been described before in an infectious pneumonia; therefore the third webinar of the PVRI2021 Digital: Complete Webinar series, entitled “Connection between COVID-19 and pulmonary vascular disease” will provide us new insights. Since emerging coronaviruses have created global health concerns in the last two decades, the first presentation will focus on the impact of coronavirus infections on our lives. Τhe next two presentations will investigate the mechanisms behind endothelitis and angiogenesis, as well as the venous thromboembolism seen in such patients and its prevalence. Pulmonary vascular disease (PVD) appears to be a major component of COVID-19 infection; therefore the forth presentation will examine the role of ACE-II receptor on PVD modulation in this disease. Last but not least, the two best abstracts will (1) focus on the usefulness of tricuspid regurgitation assessment in COVID-19-related acute pulmonary hypertension, and (2) present a systematic review and meta- analysis on venous and arterial thromboembolism in COVID-19.
SARS-1, MERS, SARS-2 and more: are coronavirus infections an ubiquitous part of our lives?
Presenter: // Albert Osterhaus, University of Veterinary Medicine Hannover, Germany
Awaiting further information.
Endothelitis and aberrant angiogenesis – mechanisms of COVID-19 induced vascular injury
Presenter: // Danny Jonigk, Hannover Medical School, Germany
Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.
Venous thromboembolism in COVID-19: Prevalence and clinical picture
Presenter: // Stavros Konstantinides , University Medical Center of Mainz, Germany
The clinical spectrum of COVID-19 is broad. Many patients will experience no, or only minor non-specific symptoms, but in some cases severe disease may develop, progressing from pneumonia to the acute respiratory distress syndrome and shock with multi-organ failure. The cytokine storm following the viral infection elicits an acute systemic inflammatory response and severe endothelial damage; these changes may result in potentially life-threatening thrombosis. Haemostatic laboratory abnormalities, including marked elevations of D-dimer and fibrinogen levels, are frequently observed in patients with COVID-19, and they have been associated with an unfavourable in-hospital outcomes (1). In parallel, the clinically reported prevalence rate of venous thromboembolism among hospitalized patients with COVID-19 was in the range of 20-36% (2-5), or even higher (6), depending on the overall severity of COVID-19. Arterial thrombosis or thromboembolism are less frequent (3, 4). Importantly, thrombotic events contribute to COVID-19-associated morbidity and mortality (7). It is therefore recommended to adhere to the standards for the prevention, diagnosis and management of thrombosis associated with COVID-19 in clinical practice:
1) Thromboprophylaxis. Recommendations on prophylactic anticoagulation should be followed in all hospitalized patients with COVID-19. Prophylactic anticoagulation in selected ambulatory patients is currently undergoing testing in randomized trials. As for the dose, standard prophylactic doses of low molecular weight heparin should generally be used. Administration of higher, intermediate or even therapeutic doses of heparin is empirically considered for severely ill patients and currently under evaluation in ongoing trials.
2) Awareness and suspicion of thrombosis. Unexpected respiratory worsening, new or unexplained tachycardia, a fall in blood pressure not attributable to tachyarrhythmia, hypovolaemia or sepsis, new-onset ECG changes suggestive of pulmonary embolism, and signs of deep vein thrombosis of the extremities, all should trigger a suspicion of pulmonary embolism (8).
3) Diagnosis and treatment of pulmonary embolism. Current guideline recommendations on the diagnosis and treatment of acute pulmonary embolism must be followed (9). The need to rationalize the available resources during a pandemic, and the adherence to isolation precautions when considering diagnostic (computed tomography pulmonary angiography, bedside echocardiography) or therapeutic procedures (catheter-directed interventions) should be taken into account in institutional clinical protocols.
ACE-II receptors – Modulation of PVD in COVID-19?
Presenter: // Anna Hemnes, Vanderbilt University, USA
There has been longstanding interest in the role of ACE2 in the pulmonary vasculature. ACE2 catalyzes the degradation of Angiotensin II to Angiotensin (1-7), which in turn stimulates the Mas receptor and may meliorate pulmonary vascular disease through this receptor. More recently, ACE2 has been recognized as the functional receptor for COVID-19 and shown to have high level expression in the lung, including the epithelium. Clinically, COVID-19 is a disease that affects the lungs including the pulmonary vasculature with increased rates of pulmonary embolism compared with other, similar populations. This talk will review recent literature understanding how ACE2 may mediate pulmonary vascular disease in COVID-19 infection and whether this may be an impactful therapeutic target in COVID-19.
Presenter: // Claes Frostell
Abstract topic: // Tricuspid regurgitation, as proxy for acute pulmonary hypertension, and its association with short-term outcome in severe Covid-19
Presenter: // Vicky Mai
Abstract topic: // Venous and arterial thromboembolism in COVID-19: a systematic review with meta-analysis
Attendees are able to claim up to 2 EACCME credits for this webinar. Please contact firstname.lastname@example.org in order to claim.
Through worldwide collaboration, we can begin to answer the question of a global disease.