RESEARCH ARTICLE


Relationship between Plasma D-Dimer Level and Pulmonary Hypertension as well as Right Ventricle Dysfunction in Patient Post Pneumonia COVID-19



Arman Christiawan1, *, Susi Herminingsih1, Udin Bahrudin1, Nur Farhanah2
1 Cardiovascular Department, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia
2 Internal Medicine Department, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia


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Creative Commons License
© 2023 Christiawan et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Cardiovascular Department, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia; E-mail: arman.chris@gmail.com


Abstract

Background:

High rate of coagulopathy and pulmonary thromboembolism in coronavirus disease 2019 (COVID-19), which is represented by an increase in plasma D-Dimer levels is believed to be related to pulmonary hypertension (PH) and right ventricle (RV) dysfunction.

Objective:

To evaluate the relationship between plasma D-Dimer levels with PH and RV dysfunction assessed from transthoracic echocardiography (TTE) in patients post COVID-19 pneumonia.

Methods:

Observational research with a cross-sectional design. Estimated mean pulmonary arterial pressure (mPAP) was calculated from Mahan's formula obtained from pulmonary artery acceleration time (PAAT) and RV function was assessed from RV free wall strain (RV FWS), tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). D-Dimer levels during hospitalisation were obtained from medical records and actual D-Dimer was obtained at the time of echocardiography.

Results:

Total 40 patients post-COVID-19 pneumonia underwent TTE in a median of 11 days after negative PCR. There was a significant correlation between peak D-Dimer levels with mPAP (r=0.526, p<0.001), RV FWS (r=-0.506, p=0.001), TAPSE (r=-0.498, p=0.001), and FAC (r=0.447, p=0.004). Multivariate analysis found peak D-Dimer ≥4530 µg/L independently associated with PH with odds ratio (OR) 6.6, (95% CI 1.1-10; p=0.048), but not with RV dysfunction.

Conclusion:

Peak D-Dimer level correlates with echocardiographic parameters of RV function and mPAP in patients with COVID-19 infection. Peak D-Dimer ≥4530 µg/L might increase risk of PH, but not RV dysfunction in patient post pneumonia COVID-19.

Keywords: D-Dimer, COVID-19, Pneumonia Pulmonary hypertension, Right ventricle dysfunction, Pneumonia, ARDS.