Introduction: COVID-19 is associated with increased thromboembolic risk. During first pandemic wave this association was not yet known, so no targeted prophylactic therapy was administered. No data is present on right ventricular (RV) disfunction and pulmonary arterial pressure increase in long-term COVID-19 patients (pts) follow-up, even if without pulmonary embolism (PE) diagnosis during hospitalization.

Aims: In view of high risk of chronic thromboembolic pulmonary disease (CTEPD), we studied echocardiographic pulmonary hypertension (PH) signs in pts after 2 years from COVID infection recovery.

Methods: We selected 40 of 106 pts hospitalized during first pandemic wave. A transthoracic echocardiography (TTE) after 2 years was performed. 18(45%) undergone oro-tracheal intubation, 14(35%) treated with c-PAP helmet and 8(20%) requiring high-flow O₂ support. Inclusion criteria were at least one among: mMRC >0 (75%), WHO class >1 (45%), 6-minute walking test desaturation >3% (12,5%), FVC%/DLCO% ratio >1.5 (17,5%), diagnosis of deep vein thrombosis (20%) and/or PE during hospitalization (10%).

Results: None of the selected pts showed manifest signs of PH. One patient performed a pulmonary V/Q scan (low probability of PE) for suspected PH. However, we found a hyperkinetic response of RV with increased TAPSE >20mm in all pts (100%) and reduced aCT value <100 msec in 8(20%) pts. Severity of Covid-19 infection was not correlated with TTE alterations.

Conclusions: The hyperkinetic state of RV found might reflect the presence of elevated pulmonary vascular resistances and increased risk to develop CTEPD in an extended period.