Busana Mattia, Schiavone Marco, Lanfranchi Antonio, Battista Forleo Giovanni, Ceriani Elisa, Beatrice Cogliati Chiara, Gasperetti Alessio
Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
Physiol Rep. 2020 Oct;8(20):e14628. doi: 10.14814/phy2.14628.
Little is known about the systemic and pulmonary macrohemodynamics in early COVID-19 infection. Echocardiography may provide useful insights into COVID-19 physiopathology.
Twenty-three COVID-19 patients were enrolled in a medical ward. Gas exchange, transthoracic echocardiographic, and hemodynamic variables were collected.
Mean age was 57 ± 17 years. The patients were hypoxemic (PaO /FiO = 273.0 ± 102.6 mmHg) and mildly hypocapnic (PaCO = 36.2 ± 6.3 mmHg, pH = 7.45 ± 0.03). Mean arterial pressure was decreased (86.7 [80.0-88.3] mmHg). Cardiac index was elevated (4.32 ± 0.90 L∙min ∙m ) and the resulting systemic vascular resistance index low (1,458 [1358-1664] dyn∙s∙cm ∙m ). The right heart was morphologically and functionally normal, with pulmonary artery pressure (PAPm, 18.0 ± 2.9 mmHg) and Total Pulmonary Resistances (TPR, 2.3 [2.1-2.7] mmHg∙l ∙min ) within normal limits. When stratifying for SVRI, patients with an SVRI value below the cohort median had also more severe oxygenation impairment and lower TPR, despite a similar degree of CXR infiltrates. Oxygen delivery index in this group resulted supranormal.
In the early stages of COVID-19 infection the hemodynamic profile is characterized by a hyperdynamic circulatory state with high CI and low SVRI, while the right heart is functionally unaffected. Our findings suggest that hypoxemia, viral sepsis or peripheral shunting are possible mechanisms for the vasodilation that dominates at this stage of the disease and may itself worsen the gas exchange.
关于新冠病毒病（COVID-19）早期感染时的全身和肺部宏观血流动力学情况，人们了解甚少。超声心动图可能为COVID-19的病理生理学提供有用的见解。
23例COVID-19患者入住内科病房。收集气体交换、经胸超声心动图和血流动力学变量。
平均年龄为57±17岁。患者存在低氧血症（动脉血氧分压/吸入氧分数值[PaO₂/FiO₂]=273.0±102.6mmHg）且轻度低碳酸血症（动脉血二氧化碳分压[PaCO₂]=36.2±6.3mmHg，pH=7.45±0.03）。平均动脉压降低（86.7[80.0 - 88.3]mmHg）。心脏指数升高（4.32±0.90L·min⁻¹·m⁻²），导致全身血管阻力指数降低（1458[1358 - 1664]dyn·s·cm⁻⁵·m²）。右心在形态和功能上正常，肺动脉压（平均肺动脉压[PAPm]，18.0±2.9mmHg）和总肺阻力（TPR，2.3[2.1 - 2.7]mmHg·l⁻¹·min⁻¹）在正常范围内。按全身血管阻力指数（SVRI）分层时，SVRI值低于队列中位数的患者尽管胸部X线浸润程度相似，但也有更严重的氧合障碍和更低的TPR。该组的氧输送指数超常。
在COVID-19感染的早期阶段，血流动力学特征为高动力循环状态，心脏指数高而全身血管阻力指数低，而右心功能未受影响。我们的研究结果表明，低氧血症、病毒血症或外周分流可能是该疾病此阶段主导血管舒张的机制，且其本身可能会使气体交换恶化。
