In the first presentation of the third PVRI webinar entitled: “Connection between COVID-19 and pulmonary vascular disease”, Dr Albert Osterhaus presented a thorough overview of coronaviruses that have caused two major epidemics in the last twenty years, namely SARS-1 and MERS, and the ongoing pandemic, i.e. SARS-2. Dr Osterhaus mentioned the zoonotic origins of the infections, analyzed the possible scenarios of the current pandemic and highlighted the importance of a global pandemic preparedness plan.
Following, Dr Danny Jonigk in his talk presented the distinct morphological and molecular angiocentric changes found in lung autopsies from COVID-19 patients compared to ARDS secondary to influenza A infection lungs. In COVID-19 the first distinct feature is severe endothelial injury and disruption of the blood-gas-barrier. The second is widespread thrombosis with microangiopathy, where in particular microthrombi are nine times more prevalent than in influenza infected lungs. The third feature is intussusceptive angiogenesis as the predominant angiogenic mechanism.
Dr Stavros Konstantinides, in the third talk, presented the European guidelines for the prevention, diagnosis and management of patients with acute pulmonary embolism and how these guidelines should be applied to COVID-19. There is a pathophysiological association between thrombosis and COVID-19 hospitalised patients. However, attending physicians should follow the recommendations on thromboprophylactic treatment. COVID-19–related thrombotic events are associated with worse clinical outcomes and therefore physicians should be prepared for an acute pulmonary embolism episode. The diagnosis and treatment of COVID-19 patients with pulmonary embolism, as well as their post hospital discharge follow-up should comply with the current guidelines.
The last presentation by Dr Anna Hemnes discussed the recent literature on the role of angiotensin converting enzyme 2 (ACE2) in modulation of pulmonary vascular disease (PVD) in COVID-19. Binding of SARS-COV-2 with the membrane-bound ACE2 triggers viral entrance into cells. ACE2 is important for the maintenance of pulmonary vascular homeostasis and also appears to be involved in pulmonary embolism (PΕ) and pulmonary arterial hypertension (PAH). To date, there are relatively little data of the role of ACE2 in COVID-19-associated PE and the outcomes of COVID-19 in PAH patients. A better understanding of the role of ACE2 in COVID-19-related PVD could provide us with new therapeutic strategies.
Finally, the webinar was concluded with the Best Abstract section. Firstly, Dr Claes Frostell presented whether acute pulmonary hypertension (aPH) and/or right ventricular strain (RVS) are associated with COVID-19 severity and outcome. Findings from 50 critically-ill COVID-19 patients showed that 52% displayed a measurable tricuspid regurgitation (TR) and had also increased short term mortality. Then, Dr Vicky Mai presented a systematic review with meta-analysis from 102 studies demonstrating that venous thromboembolism is significant (23.2%) amongst critically-ill COVID-19 patients.
Summary by Chrysa Keskinidou, University of Athens Medical School
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