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?:abstract
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AIMS: Interstitial pneumonia due to 2019 coronavirus disease (COVID-19) is often complicated by severe respiratory failure In addition to reduced lung compliance and ventilation/perfusion mismatch, a blunted hypoxic pulmonary vasoconstriction has been hypothesized, that could explain part of the peculiar pathophysiology of the COVID-19 cardio-respiratory syndrome However, no invasive hemodynamic characterization of COVID-19 patients has been reported so far METHODS AND RESULTS: Twenty-one mechanically-ventilated COVID-19 patients underwent right heart catheterization Their data were compared both with those obtained from non-mechanically-ventilated paired control subjects matched for age, sex and body mass index, and with pooled data of 1937 patients with \'typical\' acute respiratory distress syndrome (ARDS) from a systematic literature review Cardiac index was higher in COVID-19 patients than in controls (3 8 [2 7-4 5] vs 2 4 [2 1-2 8] L/min/m(2) , p<0 001), but slightly lower than in ARDS (p=0 024) Intrapulmonary shunt and lung compliance were inversely related in COVID-19 (r=-0 57, p=0 011) and did not differ from ARDS Despite this, pulmonary vascular resistance of COVID-19 was normal, similar to that of control subjects (1 6 [1 1-2 5] vs 1 6 [0 9-2 0] WU, p=0 343), and lower than reported in ARDS (p<0 01) Pulmonary hypertension was present in 76% of COVID-19 and in 19% of control subjects (p<0 001), and it was always post-capillary Pulmonary artery wedge pressure was higher in COVID-19 than in ARDS, and inversely related to lung compliance (r=-0 46, p=0 038) CONCLUSIONS: The hemodynamic profile of COVID-19 patients needing mechanical ventilation is characterized by combined cardio-pulmonary alterations Low pulmonary vascular resistance, coherent with a blunted hypoxic vasoconstriction is associated with high cardiac output and post-capillary pulmonary hypertension, that could eventually contribute to lung stiffness, and promote a vicious circle between the lung and the heart This article is protected by copyright All rights reserved
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