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Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension.

  • Nuche, Jorge1, 2, 3, 4
  • Segura de la Cal, Teresa2
  • Jiménez López Guarch, Carmen1, 2, 4
  • López-Medrano, Francisco4, 5
  • Delgado, Carmen Pérez-Olivares2
  • Ynsaurriaga, Fernando Arribas1, 2, 4
  • Delgado, Juan F1, 2, 4
  • Ibáñez, Borja1, 3, 6
  • Oliver, Eduardo1, 3
  • Subías, Pilar Escribano1, 2, 4
  • 1 Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain. , (Spain)
  • 2 Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), 28041 Madrid, Spain. , (Spain)
  • 3 Centro Nacional de Investigaciones Cardiovasculares, 28029 Madrid, Spain. , (Spain)
  • 4 Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain. , (Spain)
  • 5 Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigacioón Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain. , (Spain)
  • 6 IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain. , (Spain)
Published Article
Diagnostics (Basel, Switzerland)
Publication Date
Jul 31, 2020
DOI: 10.3390/diagnostics10080548
PMID: 32752129


The Coronavirus Disease of 2019 (COVID-19) has supposed a global health emergency affecting millions of people, with particular severity in the elderly and patients with previous comorbidities, especially those with cardiovascular disease. Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) could represent an especially vulnerable population because of the high mortality rates reported for respiratory infections. However, the number of COVID-19 cases reported among PAH and CTEPH patients is surprisingly low. Furthermore, the clinical picture that has been described in these patients is far from the severity that experts would expect. Endothelial dysfunction is a common feature between patients with PAH/CTEPH and COVID-19, leading to ventilation/perfusion mismatch, vasoconstriction, thrombosis and inflammation. In this picture, the angiotensin-converting enzyme 2 plays an essential role, being directly involved in the pathophysiology of both clinical entities. Some of these common characteristics could explain the good adaptation of PAH and CTEPH patients to COVID-19, who could also have obtained a benefit from the disease's specific treatments (anticoagulant and pulmonary vasodilators), probably due to its protective effect on the endothelium. Additionally, these common features could also lead to PAH/CTEPH as a potential sequelae of COVID-19. Throughout this comprehensive review, we describe the similarities and differences between both conditions and the possible pathophysiological and therapeutic-based mechanisms leading to the low incidence and severity of COVID-19 reported in PAH/CTEPH patients to date. Nevertheless, international registries should look carefully into this population for better understanding and management.

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