Evaluation of pulmonary hemodynamics via right heart catheterization in COVID-19 survivors

Abstract Background Pulmonary hypertension (PH) has emerged as a major clinical concern in COVID-19 survivors, particularly in those with prior moderate to severe pneumonia. Proposed mechanisms include interstitial lung disease (ILD), chronic thromboembolic pulmonary hypertension (CTEPH), and direct pulmonary vascular injury. While echocardiography provides a useful non-invasive screening tool, right heart catheterization (RHC) remains the gold standard for definitive diagnosis and hemodynamic assessment. This study aimed to evaluate pulmonary hemodynamics in COVID-19 survivors using RHC and to determine the prevalence, severity, and underlying etiologies of post-COVID PH. Methods This prospective cross-sectional study was conducted at Mansoura University Hospitals between April 2022 and March 2024. A total of 230 COVID-19 survivors were screened, and 20 patients meeting eligibility criteria underwent comprehensive clinical, laboratory, radiological, echocardiographic, and hemodynamic evaluation using RHC. Patients were further classified according to the etiology of post-COVID-19 PH. Results The study cohort (mean age 41.2 ± 10.8 years; 65% female) demonstrated advanced functional impairment, with 85% in WHO functional class III–IV and markedly reduced 6MWD (366 ± 88 m). Laboratory analysis revealed persistent immune activation and elevated thrombotic markers, while imaging identified moderate lung involvement and pulmonary arterial filling defects in 25% of cases. Echocardiography showed elevated sPAP (mean 83 ± 23 mmHg) and impaired RV–PA coupling. RHC confirmed pre-capillary PH in all patients, with mean mPAP 56 ± 15 mmHg, mean PVR 9.6 ± 6 WU, and preserved PCWP. Etiological classification revealed post-COVID interstitial lung disease–related PH (PCILD-PH) as most common (55%), followed by CTEPH/CTED (25%) and COVID-19–associated PAH (20%). Conclusion Pulmonary hypertension is a concerning sequela in COVID-19 survivors, with interstitial lung disease representing the predominant mechanism. Echocardiography is valuable for initial screening, but RHC remains indispensable for accurate diagnosis and risk stratification. These findings underscore the need for systematic follow-up and tailored management strategies to prevent further complications and improve long-term outcomes.