The Relationship between Basal Serum Lipoprotein(a) Levels and the Pulmonary Artery to Ascending Aorta Ratio in COVID-19 Survivors

Abstract

Coronavirus disease has recently been added to the medical literature and has affected millions of people. 1 Although COVID-19 was identified as a respiratory system disease in the early stages of the pandemic, it is now considered a multisystem disease. 2 Various clinical manifestations related to endothelial cell dysfunction, autonomic nervous system damage, and microvascular and lung tissue damage can be observed in the early or late stages of COVID-19. 3 A recent study showed that endothelial cell damage may result in impaired arterial wall function and consequently reduced or impaired aortic elasticity within 3 to 6 months in COVID-19 survivors. 4 Another recent study showed that impaired cardiac performance can be seen as a result of loss of endothelial and vascular function due to Lipoprotein(a) [Lp(a)] consists of low-density lipoprotein particles. 6 Lp(a) is present in humans at low and stable levels and may increase during infections due to cytokine storm and various mechanisms. 7 Lp(a) can cause oxidized phospholipids to accumulate in the arterial wall, causing inflammation and resulting in loss of function in endothelial cells. 8 The pulmonary artery (PA) to ascending aorta (Ao) ratio (PA:Ao ratio) has been analyzed by various imaging modalities such as cardiac magnetic resonance and computed tomography (CT). 9,10