COVID-19入院患者の肺高血圧と右室病変

Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19.

• Matteo Pagnesi
• Luca Baldetti
• Alessandro Beneduce
• Francesco Calvo
• Mario Gramegna
• Vittorio Pazzanese
• Giacomo Ingallina
• Antonio Napolano
• Renato Finazzi
• Annalisa Ruggeri
• Silvia Ajello
• Giulio Melisurgo
• Paolo Guido Camici
• Paolo Scarpellini
• Moreno Tresoldi
• Giovanni Landoni
• Fabio Ciceri
• Anna Mara Scandroglio
• Eustachio Agricola
• Alberto Maria Cappelletti

抄録

目的:

コロナウイルス疾患2019（COVID-19）の入院した非集中治療室（ICU）患者における肺高血圧（PH）および右室機能障害（RVD）の有病率、特徴、予後を評価すること。

OBJECTIVE: To assess the prevalence, characteristics and prognostic value of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in hospitalised, non-intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).

方法:

この単施設、観察的、横断的研究では、非集中治療室（ICU）部門に入院した COVID-19 患者 211 例を対象に、1 回の経胸腔心エコー検査（TTE）を実施した。音響窓が不良な患者（n=11）は除外した。PH（推定収縮期肺動脈圧>35mmHg）を有する患者と有さない患者、およびRVD（三尖頭環状面収縮期エクスカーション<17mmまたはS波<9.5cm/s）を有する患者と有さない患者で、臨床所見、画像所見、検査所見、およびTTE所見を比較した。主要エンドポイントは院内死亡またはICU入院とした。

METHODS: This single-centre, observational, cross-sectional study included 211 patients with COVID-19 admitted to non-ICU departments who underwent a single transthoracic echocardiography (TTE). Patients with poor acoustic window (n=11) were excluded. Clinical, imaging, laboratory and TTE findings were compared in patients with versus without PH (estimated systolic pulmonary artery pressure >35 mm Hg) and with versus without RVD (tricuspid annular plane systolic excursion <17 mm or S wave <9.5 cm/s). The primary endpoint was in-hospital death or ICU admission.

結果:

最終解析には合計200人の患者が含まれた（年齢中央値62歳（IQR52～74）、男性65.5％）。PHとRVDの有病率はそれぞれ12.0％（24/200例）と14.5％（29/200例）であった。PH患者は、PHなしの患者に比べて高齢で、既往の心臓合併症やより重症の急性呼吸器症候群コロナウイルス2（SARS-CoV-2）感染の徴候（肺の放射線学的病変、臨床検査所見、酸素状態）の負担が高かった。逆に、RVD患者では、既往の心臓合併症の負担は高かったが、RVDなしの患者に比べて重症のSARS-CoV-2感染は認められなかった。PHの存在は院内死亡またはICU入院率の高さと関連していた（41.7 vs 8.5%、p<0.001）が、RVDの存在は関連していなかった（17.2 vs 11.7%、p=0.404）。

RESULTS: A total of 200 patients were included in the final analysis (median age 62 (IQR 52-74) years, 65.5% men). The prevalence of PH and RVD was 12.0% (24/200) and 14.5% (29/200), respectively. Patients with PH were older and had a higher burden of pre-existing cardiac comorbidities and signs of more severe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (radiological lung involvement, laboratory findings and oxygenation status) compared with those without PH. Conversely, patients with RVD had a higher burden of pre-existing cardiac comorbidities but no evidence of more severe SARS-CoV-2 infection compared with those without RVD. The presence of PH was associated with a higher rate of in-hospital death or ICU admission (41.7 vs 8.5%, p<0.001), while the presence of RVD was not (17.2 vs 11.7%, p=0.404).

結論:

COVID-19を有する入院中の非ICU患者において、PH（RVDではなく）はより重度のCOVID-19の徴候を示し、院内臨床転帰の悪化と関連していた。

CONCLUSIONS: Among hospitalised non-ICU patients with COVID-19, PH (and not RVD) was associated with signs of more severe COVID-19 and with worse in-hospital clinical outcome.

トライアル登録番号:

NCT04318366。

TRIAL REGISTRATION NUMBER: NCT04318366.

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.