Determinants of endothelial dysfunction in noncritically ill hospitalized COVID‐19 patients: A cross‐sectional study

Heubel, Alessandro Domingues; Viana, Ariane Aparecida; Linares, Stephanie Nogueira; Amaral, Vanessa Teixeira do; Schafauser, Nathany Souza; Oliveira, Gustavo Yudi Orikassa de; Ramírez, Paula Camila; Martinelli, Bruno; Alexandre, Tiago da Silva; Silva, Audrey Borghi; Ciolac, Emmanuel Gomes; Mendes, Renata Gonçalves

doi:10.1002/oby.23311

Cited by 12 publications

(12 citation statements)

References 43 publications

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“…To our knowledge, this is the largest study extensively investigating the association between bFMD, a potential clinical and non-invasive measure of endothelial function, and in-hospital outcomes of COVID-19 patients. Indeed, in some recent studies in which bFMD was evaluated in patients with recent or ongoing COVID-19, the association between bFMD and the in-hospital prognosis of enrolled patients was not assessed [25][26][27]. In addition, a recent observational study involving 98 patients with confirmed COVID-19 investigated only the prospective association between bFMD and in-hospital mortality [28].…”

Section: Discussionmentioning

confidence: 99%

Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

Bianconi

Mannarino

Figorilli

et al. 2021

JCM

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Background: Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients. Methods: Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses. Results: Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs (p < 0.001, p = 0.001, and p < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155–2.428, p = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death. Conclusions: Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission.

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Section: Discussionmentioning

confidence: 99%

Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

Bianconi

Mannarino

Figorilli

et al. 2021

JCM

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“…However, even under adequate medical treatment, pneumonia caused by SARS-CoV-2 infection may cause an injury to the lung parenchyma, with permanent structural damage (3). Studies have also shown a direct relationship between COVID-19 and poor cardiovascular outcomes, such as increased arterial stiffness, and an association between overweight and endothelial dysfunction (4)(5)(6)(7). Initial investigations showed that SARS-CoV-2 is able to infect the endothelial cells, which are responsible for regulating vascular tone (8) harming the vascular function of these individuals (6).…”

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confidence: 99%

Cardiovascular, Respiratory, and Functional Effects of Home-Based Exercise Training after COVID-19 Hospitalization

Amaral

Viana

Heubel

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction: The present randomized, single-center, and single-blinded clinical trial tested the hypothesis that tele-supervised homebased exercise training (exercise) is an effective strategy for improving cardiovascular, respiratory, and functional capacity parameters in individuals who were hospitalized due to coronavirus disease 2019 . Methods: Thirty-two individuals (52 ± 10 yr; 17 were female) randomly assigned to exercise (n = 12) or control groups (n = 20) had their anthropometric (weight, body mass index), hemodynamic (brachial and central blood pressure), vascular (arterial stiffness), ventilatory (pulmonary function and respiratory muscle strength), and functional parameters (handgrip strength, five-time sit to stand, timed up and go test, and 6-min walking test) assessed at baseline (30-45 d of hospital discharged) and after 12 wk of follow-up. Results: Both groups similarly increased ( P < 0.001) forced vital capacity (absolute and percent of predicted), forced expiratory volume in the first second (absolute and percent of predicted), and handgrip strength during follow-up. However, only the exercise group reduced carotid-femoral pulse wave velocity (−2.0 ± 0.6 m•s −1 , P = 0.048) and increased ( P < 0.05) resting oxygen saturation (1.9% ± 0.6%), mean inspiratory pressure (24.7 ± 7.1 cm H 2 O), mean expiratory pressure (20.3 ± 5.8 cm H 2 O), and percent of predicted mean expiratory pressure (14% ± 22%) during follow-up. No significant changes were found in any other variable during follow-up. Conclusions: Present findings suggest that tele-supervised home-based exercise training can be a potential adjunct therapeutic to rehabilitate individuals who were hospitalized due to COVID-19.

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“…Seventeen studies have examined the association of COVID‐19 with endothelial function. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Notably, it should be acknowledged that of the 16 studies assessing endothelial dysfunction through FMD, only four studies clearly adjusted FMD measurement for shear stress indices. Τhus, residual confounding regarding the association between endothelial dysfunction and outcomes in acute and post‐recovery COVID‐19 cannot be excluded.…”

Section: Resultsmentioning

confidence: 99%

“…Increased body mass index and renal disease have been both associated with endothelial dysfunction in noncritically hospitalized patients with COVID‐19. 18 Additionally, patients with type 2 diabetes and under treatment with beta blockers or angiotensin receptor blockers (ARBs) presented significantly lower FMD values. 14 Importantly, higher values of interleukin‐6 and troponin I during hospitalization were also associated with impaired endothelial function at the acute phase.…”

Section: Discussionmentioning

confidence: 99%

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

Mavraganis

Dimopoulou

Bampatsias

et al. 2022

Eur J Clin Investigation

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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.

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Determinants of endothelial dysfunction in noncritically ill hospitalized COVID‐19 patients: A cross‐sectional study

Cited by 12 publications

References 43 publications

Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

Cardiovascular, Respiratory, and Functional Effects of Home-Based Exercise Training after COVID-19 Hospitalization

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

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