Influence of Plasma Hemostasis on Intracardiac Hemodynamics in Patients with Chronic Coronary Heart Disease and COVID-19

In COVID-19 coronavirus disease, plasma hemostasis dysfunction and intracardiac hemodynamics (ICH) are observed, which increase the risk of thromboembolic complications and cardiovascular events. The aim of our study was to investigate the impact of COVID-19 on the interdependence of changes in the plasma hemostasis system and intracardiac hemodynamics in patients with chronic coronary artery disease (CHD). We analyzed the laboratory and instrumental results of 386 patients who were divided into 3 groups: Group 1 - CHD without COVID-19 (n = 79); Group 2 - CHD in combination with COVID-19 (n = 127); Group 3 - COVID-19 without CHD (n = 180). The control group included 37 conditionally healthy volunteers. Changes in plasma hemostasis were studied using an automatic blood coagulation analyzer K 3002 OPTIS (KSELMED), Poland. Echocardiography was performed on the HDI 11XE and MyLabXE8 XP. In patients with chronic coronary artery disease with concomitant COVID-19, a wide range of plasma hemostatic disorders were observed, including increased levels of soluble fibrin monomer complexes, XII-a (Hageman) dependent fibrinolysis, and decreased levels of protein C and antithrombin III. The profile of CHD in combination with COVID-19, in contrast to the “isolated” passing of both conditions, was characterized by a more pronounced disturbance of intracardiac hemodynamics. Patients with chronic coronary artery disease, in particular in combination with COVID-19, showed signs of left and right ventricular remodeling and increased systolic pressure in the pulmonary artery according to echocardiography. Patients with chronic coronary artery disease who have had COVID-19 have a more pronounced activation of plasma hemostasis compared to patients with coronary artery disease alone or COVID-19. COVID-19 contributes to the deterioration of left ventricular systolic function and left ventricular remodeling in patients with chronic CHD, which correlates with fibrinogen and protein C and antithrombin III levels. Increased systolic pressure in the pulmonary artery and right ventricular dilatation in patients with CHD and COVID-19 may indicate the development of pulmonary hypertension and an increased risk of right ventricular failure. Thus, patients with chronic CHD and concomitant COVID-19 along with dysfunction of the plasma hemostasis system showed signs of intracardiac hemodynamics of the left ventricle. Additional consideration of the characteristics of plasma hemostasis and intracardiac hemodynamics is advisable in managing such patients.