David Chipayo-Gonzales

Background: Concern has risen about the effects of COVID-19 in interstitial lung disease (ILD) patients. The aim of our study was to determine clinical characteristics and prognostic factors of ILD patients admitted for COVID-19. Methods: Ancillary analysis of an international, multicenter COVID-19 registry (HOPE: Health Outcome Predictive Evaluation) was performed. The subgroup of ILD patients was selected and compared with the rest of the cohort. Results: A total of 114 patients with ILDs were evaluated. Mean ± SD age was 72.4 ± 13.6 years, and 65.8% were men. ILD patients were older, had more comorbidities, received more home oxygen therapy and more frequently had respiratory failure upon admission than non-ILD patients (all p < 0.05). In laboratory findings, ILD patients more frequently had elevated LDH, C-reactive protein, and D-dimer levels (all p < 0.05). A multivariate analysis showed that chronic kidney disease and respiratory insufficiency on admission were predictors of ventilatory support, and that older age, kidney disease and elevated LDH were predictors of death. Conclusions: Our data show that ILD patients admitted for COVID-19 are older, have more comorbidities, more frequently require ventilatory support and have higher mortality than those without ILDs. Older age, kidney disease and LDH were independent predictors of mortality in this population.

A 67-year-old female with history of eosinophilic gastritis, was admitted with a first episode of heart failure (HF). The X-ray showed a bilateral interstitial infiltrate with a large left pleural effusion (Panel A), with abundant eosinophils in the pleural drainage and eosinophilia in blood stream (22 × 10⁹, normal value 0,5–1 × 10⁹). The transthoracic echocardiogram observed a normal left ventricular function (53%) (see Supplementary Video S1) with restrictive mitral filling pattern (Panel B) and a severely diminished global longitudinal strain of—9.6% (Panel C). The cardiac resonance (see Supplementary Video S2) revealed a septal intramyocardial and anterolateral subepicardial late gadolinium enhancement (Panels D and E) with normal right ventricle function, non-thickened pericardium, and no effusions. Due to high suspicious of a restrictive myocardiopathy (RMC) secondary to a hyperosinophilic syndrome, a right heart catheterization (RHC) and a cardiac biopsy were scheduled. The RHC was compatible with RMC (Panel F), with pulmonary hypertension (mean pulmonary pressure of 28 mmHg), ‘dip & plateau pattern’, and pressure equalization between chambers. Finally, the endomyocardial biopsy (Panel G) revealed an important infiltration of eosinophils in myocardial tissue, confirming the diagnosis of eosinophilic myocarditis (EM), in the context of hypereosinophilic syndrome. High doses of intravenous corticoids plus HF treatment were started, and the patient evolved favourably.

A 68-year-old female presented with an intermediate-high-risk bilateral pulmonary embolism (PE) (Panel A) with a severely dilated right ventricle (Panel B). Ultrasound of both femoral veins was normal. Thrombolysis was not performed owing to recent history of gastrointestinal bleeding. The PE team decided to perform a percutaneous mechanical thrombectomy (MT) using the FlowTriever (FT) system (Inari Medical, Irvine, CA, USA). After the first procedure, a large thrombus was obtained from the right pulmonary artery (Panels C–E and Supplementary Video 1); however, we failed to extract any thrombus from the left pulmonary artery (LPA) with both the 24 and 16 Fr catheters, due to tortuosity and poor wire support, with non-sustained ventricular tachycardia. A transthoracic echocardiogram (TTE) and a subsequent transoesophageal echocardiography revealed the presence of a massive clot attached to the tricuspid valve, with severe tricuspid regurgitation (Panels F and G and Supplementary Video 2) that was not present in baseline TTE. Considering it was an iatrogenic event due to a ‘lollipop thrombus’, and the risk of re-embolization, a further MT procedure was performed, with TTE guidance, with the successful retrieval of the clot in transit (Panels H and I), and the remaining LPA thrombi (Panels J–L, Supplementary Video 3).