Key result
Prostaglandin E1 infusion improves EF to 50% in a case of COVID-19 Takotsubo cardiomyopathy.
Why the study?
Given the role of cytokine elevation in COVID-19 acute lung injury and the vasodilator and anti-inflammatory properties of prostaglandin E1, the authors postulated PGE1 could reduce morbidity and mortality.
Does Prostaglandin E1 infusion improve clinical and echocardiographic outcomes in patients with severe cardio-pulmonary dysfunction due to COVID-19?
Case Report (n=1)
No
Does Prostaglandin E1 infusion improve clinical and echocardiographic outcomes in patients with severe cardio-pulmonary dysfunction due to COVID-19?
Prostaglandin E1 infusion may offer a synergistic therapeutic option for severe cardio-pulmonary dysfunction, including Takotsubo cardiomyopathy, in COVID-19 patients.
Hypothesis-generating for prostanoid infusion in COVID-19 cardiomyopathy; controlled trials needed before clinical adoption.
Background: One of the most challenging characteristics of the novel pandemic of COVID-19, is that there are various degrees of severity of symptoms, from asymptomatic to life-threatening forms.COVID-19 infection results in an increase in serum levels of cytokines such as interleukin-6 (IL-6) and interleukin-8 (IL-8) and their relationship with acute lung injury has been shown previously.Prostaglandin E1 is one of a family of naturally occurring acidic lipids with pulmonary and systemic vasodilator effects and anti-inflammatory properties.Starting from these considerations, we can postulate a possible role for the PGE 1 in increasing the levels of NO and might be effective in reducing mortality and morbidity in patients with COVID-19 infection.Clinical Case: A 54-old man, was admitted to Emergency Room (ER) complaining of dyspnoea and fever.Phisical examination was characterized by tachypnoea, tachycardia and hypotension and hypoxemia at transcutaneous saturation.High Resolution Computed Tomography (HRCT) showed bilateral interstitial pneumonia with ground glass opacities (visual involvement of 80% of pulmonary parenchimal).Later we decide to use prostanoid drugs in infusion.We observed a progressive clinical and echocardiography improvement, evidenced by partial recovery of EF (45%).The Patient underwent Cardiac Magnetic Resonance (CMR) that showed typical Takotsubo cardiomyopathy.Conclusion: Considering the biochemical mechanisms involved in COVID19 infection and previous experiences justifying the off-label use of PGE1 as a possible synergic drug in the treatment of COVID19 infection should be considered.
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Serra et al. (2022) conducted a case report in COVID-19 with severe cardio-pulmonary dysfunction (n=1). Prostaglandin E1 was evaluated on Clinical and echocardiographic improvement. Prostaglandin E1 infusion in a 54-year-old man with severe COVID-19 pneumonia and Takotsubo cardiomyopathy led to progressive clinical improvement and recovery of ejection fraction to 50%.
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