Pulmonary Hypertension in COVID-19 Associated With Greater Disease Severity, Worse Outcomes

In patients hospitalized for COVID-19, the presence of pulmonary hypertension may be associated with more severe presentation of the disease and worse in-hospital outcomes.

In patients hospitalized for coronavirus disease 2019 (COVID-19), the presence of pulmonary hypertension (PH) may be associated with more severe presentation of the disease and worse in-hospital outcomes, according to a study published in Heart.

A total of 200 patients with COVID-19 (median age, 62 years; n=24 with PH; n=176 without PH; n=29 with right ventricular dysfunction [RVD]; n=171 without RVD) who were admitted to a hospital in Italy were included in this observational, cross-sectional study. All patients underwent 1 transthoracic echocardiography. The study’s primary endpoint was in-hospital death or admission to the intensive care unit (ICU).

The median time from symptom onset to admission in this cohort was 7 days. Patients with vs without PH were significantly older (76 years vs 62 years, respectively; P <.001), more frequently had diabetes mellitus (P =.049), hypertension (P =.009), chronic kidney disease stages 4 to 5 (P =.007), and chronic obstructive pulmonary disease (P =.030). Patients with vs without PH also had a higher chest X-ray severity score (5 vs 3, respectively; P <.001), and a greater percentage of CXR severity scores ≥4 (70.8% vs 34.1%, respectively; P =.001).

Patients with vs without RVD had a higher burden of prior myocardial infarction (P =.005), prior coronary artery bypass graft (P <.001), prior valve intervention (P <.001), prior atrial fibrillation or flutter (P =.001), prior heart failure (P =.001), and known cardiomyopathy (P =.002).

Hospitalized patients with COVID-19 and with vs without PH were treated more frequently with noninvasive ventilation (P <.001).

At follow-up (median, 9 days), 19 patients had died, 7 patients required admission to the ICU, and 135 (67.5%) were discharged. Patients with vs without PH had a greater rate of in-hospital death or ICU admission (41.7 vs 8.5%, respectively; P <.001). There was no difference between patients with vs without RVD in terms of in-hospital mortality or admission to the ICU (17.2 vs 11.7%, respectively; P =.404).

Limitations of the study include its observational nature, the inclusion of patients from a single center, and the lack of a control group.

“Identification of PH could be prognostically relevant in hospitalized patients with COVID-19 and signs of more severe [severe acute respiratory syndrome coronavirus 2] infection,” noted the study authors.


Pagnesi M, Baldetti L, Beneduce A, et al. Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19 [published online July 16, 2020]. Heart. doi:10.1136/heartjnl-2020-317355