Prevalence of Post COVID-19 Pulmonary Arterial Hypertension and Its Clinical Association with CT Severity Score among COVID-19 Pneumonia Survivors in a Tertiary Care Hospital of Western Odisha, India

Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus targets the Angiotensin Converting Enzyme 2 (ACE2) receptor, which is abundantly present in two vital organs of the body, namely the lungs and the heart, making the pathogen devastating. Because these organs are closely linked in their pathophysiology, disease in one organ can affect the other. It has been observed that patients recovering from Coronavirus Disease 2019 (COVID-19) pneumonia can later develop fatal cardiac complications such as Pulmonary Arterial Hypertension (PAH) as a result of multiple and complex pathophysiological phenomena. PAH leads to right ventricular failure and death due to increased pulmonary vascular resistance. However, early diagnosis with appropriate medical management can increase survival and quality of life. The chest Computed Tomography (CT) severity score on High Resolution Computed Tomography (HRCT) of the lungs is a standard index for estimating the severity of pneumonia in hospitalised COVID-19 patients. Aim: To estimate the prevalence of post COVID-19 PAH and to assess the association between chest CT severity score and post COVID-19 PAH among survivors of COVID-19 pneumonia. Materials and Methods: A cross-sectional study was conducted in the Department of Cardiology, VIMSAR, Burla, Odisha, India, from October 2020 to October 2023, enrolling 854 patients with cardiac complaints in the post COVID-19 period. Severity of COVID-19 pneumonia was graded as mild, moderate, or severe according to the semiquantitative chest CT severity score method, based on the CT reports from the COVID-19 period. The enrolled patients were thoroughly examined; those with abnormal cardiac signs and Electrocardiography (ECG) or chest X-ray suggestive of underlying PAH underwent echocardiography. Diagnosis of PAH was performed according to the 2022 European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Nonparametric statistical methods, such as the Chi-square test, were used to analyse qualitative data, whereas quantitative variables were expressed as means with standard deviations, and an unpaired t-test was used to compare means between two groups. Results: The prevalence of PAH in the post COVID-19 period among pneumonia survivors was 12.1%. A total of 104 patients were diagnosed with PAH: 35 (33.7%) had severe pneumonia, 26 (25.0%) had mild pneumonia, and 43 (41.3%) had moderate pneumonia. The chest CT severity score was significantly associated with the development of post COVID-19 PAH. Conclusion: Higher chest CT severity scores during acute COVID-19 pneumonia are associated with a greater risk of developing PAH in the post COVID-19 period. Proper screening of these patients can enable earlier detection of post COVID-19 PAH.