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Original research
Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19
  1. Matteo Pagnesi1,
  2. Luca Baldetti1,
  3. Alessandro Beneduce2,
  4. Francesco Calvo1,
  5. Mario Gramegna1,
  6. Vittorio Pazzanese1,
  7. Giacomo Ingallina3,
  8. Antonio Napolano3,
  9. Renato Finazzi4,
  10. Annalisa Ruggeri5,
  11. Silvia Ajello6,
  12. Giulio Melisurgo6,
  13. Paolo Guido Camici7,
  14. Paolo Scarpellini8,
  15. Moreno Tresoldi4,
  16. Giovanni Landoni7,9,
  17. Fabio Ciceri5,7,
  18. Anna Mara Scandroglio6,9,
  19. Eustachio Agricola3,7,
  20. Alberto Maria Cappelletti1
  1. 1 Cardiac Intensive Care Unit, San Raffaele Scientific Institute, Milan, Italy
  2. 2 Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
  3. 3 Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
  4. 4 Department of General Medicine and Advanced Care, San Raffaele Scientific Institute, Milan, Italy
  5. 5 Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
  6. 6 Cardio-Thoracic Intensive Care Unit, San Raffaele Scientific Institute, Milan, Italy
  7. 7 Vita-Salute San Raffaele University, Milan, Italy
  8. 8 Department of Infectious Disease, San Raffaele Scientific Institute, Milan, Italy
  9. 9 Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
  1. Correspondence to Dr Matteo Pagnesi, Cardio-Thoracic-Vascular Department, San Raffaele Hospital, 20132 Milan, Italy; m.pagnesi{at}


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).

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.

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).

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.

Trial registration number NCT04318366

  • echocardiography
  • pulmonary vascular disease

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  • Twitter @lucabaldetti, @ABeneduceMD, @MarioGramegnaMD, @AnnalisaRugger1, @giovannilandoni, @CiceriFabio

  • MP and LB contributed equally.

  • Contributors The co-first authors (MP and LB) designed the study, performed data analyses, had full access to all the data in the study and takes responsibility for the content of the manuscript. MP, LB, AB, FC, MG, VP, GI and AN performed data acquisition and collection. MP, LB, RF, AR, SA, GM, PGC, PS, MT, GL, FC, AMS, EA and AC contributed to data interpretation and manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The COVID-BioB study (prospective, all-comers registry collecting clinical, laboratory, biologic and imaging data on all hospitalized COVID-19 patients) was approved by the Hospital Ethics Committee (protocol n. 34/int/2020).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The deidentified participant dataset generated during the current study is not publicly available and is not in a repository.

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