Clinical implications of vascular dysfunction in acute and convalescent COVID‐19: A systematic review

Abstract

Background Accumulating evidence suggests that endothelial dysfunction is implicated in the pathogenesis and severity of coronavirus disease 2019 (COVID‐19). In this context, vascular impairment in COVID‐19 might be associated with clinical manifestations and could refine risk stratification in these patients. Methods This systematic review aims to synthesize current evidence on the frequency and the prognostic value of vascular dysfunction during acute and post‐recovery COVID‐19. After systematically searching the MEDLINE, clinicaltrials.gov and the Cochrane Library from 1 December 2019 until 05 March 2022, we identified 24 eligible studies with laboratory confirmed COVID‐19 and a thorough examination of vascular function. Flow‐mediated dilation (FMD) was assessed in 5 and 12 studies in acute and post‐recovery phase respectively; pulse wave velocity (PWV) was the marker of interest in three studies in the acute and four studies in the post‐recovery phase. Results All studies except for one in the acute and in the post‐recovery phase showed positive association between vascular dysfunction and COVID‐19 infection. Endothelial dysfunction in two studies and increased arterial stiffness in three studies were related to inferior survival in COVID‐19. Discussion Overall, a detrimental effect of COVID‐19 on markers of endothelial function and arterial stiffness that could persist even for months after the resolution of the infection and provide prognostic value was congruent across published studies. Further research is warranted to elucidate clinical implications of this association.

Predictive value of inflammatory and coagulation biomarkers for venous thromboembolism in COVID-19 patients

“…We</ins> <del cite="mailto:User" datetime="2022-12-18T21 : 04">and</del> were unable to include some potentially interesting novel biomarkers, that are currently used only for research purposes. <ins cite="mailto:User" datetime="2022-12-18T21 : 04"></ins><ins cite="mailto:User" datetime="2022-12-18T21 : 05">This to be said several studies have identified endothelial dysfunction and markers of extrinsic coagulation pathway</ins> <ins cite="mailto:User" datetime="2022-12-18T21 : 06">to have an important role in</ins> <ins cite="mailto:User" datetime="2022-12-18T21 : 07">the pathophysiology of</ins> <ins cite="mailto:User" datetime="2022-12-18T21 : 06">hypercoagulation</ins> <ins cite="mailto:User" datetime="2022-12-18T21 : 10">as well as a potential prognostic impact</ins> <ins cite="mailto:User" datetime="2022-12-18T21 : 06">in Covid-19</ins> <ins cite="mailto:User" datetime="2022-12-18T21 : 07"></ins> [38][39][40]<ins cite="mailto:User" datetime="2022-12-18T21 : 06">.</ins> However, since our goal was to investigate the correlation of common biomarkers with VTE in clinical practice, we are convinced that it was a drawback of minor entity.…”

The Role of Rehabilitation in Arterial Function Properties of Convalescent COVID-19 Patients

“…Endothelial impairment at the post-acute COVID-19 phase may contribute to increased arterial stiffness. The role of systemic inflammation may also affect arterial function parameters [ 42 , 43 ]. Additionally, the role of sympathetic drive has been described in the impaired ventriculoarterial coupling of convalescent COVID-19 subjects [ 2 ], which may contribute to long COVID-19 symptoms, especially regarding functional status and fatigue.…”

Hypertension management before and under the COVID-19 pandemic: lessons and future directions

“…Pulse wave velocity (PWV) including brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV) is indices of arterial stiffness. The result of a systematic review of the association between COVID-19 infection and vascular function determined by FMD and PWV implied that COVID-19 infection impairs vascular function, and exacerbates arterial stiffness and these effects persist after COVID-19 recovery [ 22 ]. The detailed mechanisms of how COVID-19 affects blood pressure through inflammation, sympathetic nervous system dysregulation, RAS activation, and even organ or vascular damage are unknown.…”