Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Rodilla, Enrique; Lopez-Carmona, Maria Dolores; Cortés, Xavier; Cobos-Palacios, Lidia; Canales, Sergio; Saez, Maria Carmen; Escudero, Samara Campos; Rubio‐Rivas, Manuel; Díez-Manglano, Jesús; Castro, Santiago J. Freire; Piqueras, Nuria Vázquez; Sanchis, Elisabeth Mateo; Pesqueira-Fontán, P.; Gamboa, Jeffrey Oskar Magallanes; García, Andrés González; Romero, Victor; Chamorro, Lara Tamargo; Moraleja, Julio González; Martínez, Javier Villanueva; Noya, Amara González; Suárez-Lombraña, Ana; Gutiérrez, Anyuli Gracia; Reboiro, Manuel Lorenzo López; Ramos‐Rincón, José‐Manuel; Huelgas, Ricardo Gómez

doi:10.1161/hypertensionaha.120.16563

Cited by 48 publications

(64 citation statements)

References 40 publications

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“…with healthy control subjects (Ratchford et al, 2020). Likewise, a recent study using the rudimentary measure of pulse pressure as an arterial stiffness index has revealed an association between pulse pressure and all-cause mortality in patients with SARS-CoV-2 (Rodilla et al, 2021). These data suggest an impairment in vascular regulation, which might predispose individuals to a greater risk of cardiovascular disorders, such as myocardial injury, arrhythmias, acute coronary syndrome or thromboembolism (Driggin et al, 2020).…”

Section: New Findingsmentioning

confidence: 98%

Carotid stiffness, intima–media thickness and aortic augmentation index among adults with SARS‐CoV‐2

Szeghy

Province

Stute

et al. 2021

Experimental Physiology

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Contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to cause decrements in vascular function of young adults. However, less is known about the impact of SARS-CoV-2 on arterial stiffness and structure, which might have additional implications for cardiovascular health. The purpose of this study was to assess the carotid artery stiffness and structure using ultrasound and the aortic augmentation index (AIx) using applanation tonometry in young adults after they tested positive for SARS-CoV-2. We hypothesized that carotid artery stiffness, carotid intima-media thickness (cIMT) and aortic AIx would be elevated in young adults with SARS-CoV-2 compared with healthy young adults. We evaluated 15 young adults (six male and nine female; 20 ± 1 years of age; body mass index, 24 ± 3 kg m −2 ) 3-4 weeks after a positive SARS-CoV-2 test result compared with young healthy adults (five male and 10 female; 23 ± 1 years of age; body mass index, 22 ± 2 kg m −2 ) who were evaluated before the coronavirus 2019 pandemic. Carotid stiffness, Young's modulus and cIMT were assessed using ultrasound, whereas aortic AIx and aortic AIx standardized to 75 beats min −1 (AIx@HR75) were assessed from carotid pulse wave analysis using SphygmoCor. Group differences were observed for carotid stiffness (control, 5 ± 1 m s −1 ; SARS-CoV-2, 6 ± 1 m s −1 ), Young's modulus (control, 396 ± 120 kPa; SARS-CoV-2, 576 ± 224 kPa), aortic AIx (control, 3 ± 13%; SARS-CoV-2, 13 ± 9%) and aortic AIx@HR75 (control, −3 ± 16%; SARS-CoV-2, 10 ± 7%; P < 0.05). However, cIMT was similar between groups (control, 0.42 ± 0.06 mm; SARS-CoV-2, 0.44 ± 0.08 mm; P > 0.05). This cross-sectional analysis revealed higher carotid artery stiffness and aortic stiffness among young adults with SARS-CoV-2.These results provide further evidence of cardiovascular impairments among young adults recovering from SARS-CoV-2 infection, which should be considered for cardiovascular complications associated with SARS-CoV-2.

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Section: New Findingsmentioning

confidence: 98%

Carotid stiffness, intima–media thickness and aortic augmentation index among adults with SARS‐CoV‐2

Szeghy

Province

Stute

et al. 2021

Experimental Physiology

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“…The high-risk category presents socio-demographic and comorbidity characteristics already recognized as poor prognostic factors [3][4][5][6][7][8][9]. There is no definitive answer to date as to why older patients, especially men and those with certain comorbidities, become more inflamed, but what is clear is that such patients' inflammatory response is certainly greater.…”

Section: Discussionmentioning

confidence: 99%

“…After 1 year of advances in the understanding of the disease, several risk factors have been recognized [1,2]. These include older age, male gender, certain comorbidities, and phenotypic clusters based on patient symptomatology [3][4][5][6][7][8][9]. Some analytical parameters have also been identified as poor prognostic factors and are related to the inflammatory state that patients present during the disease, the so-called cytokine storm, the most characteristic features of which are a decrease in the lymphocyte count and an increase in inflammatory parameters such as C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and D-dimer [10].…”

Section: Introductionmentioning

confidence: 99%

Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry

Rubio‐Rivas

Corbella

Formiga

et al. 2021

JCM

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(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. (3) Results: A total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. (4) Conclusion: The present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters.

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“…EF1 may be influenced by arterial stiffness, which associates with mortality in COVID-19. 5 Although we adjusted for systolic blood pressure, this may be a poor surrogate of arterial stiffness especially in acute COVID-19; direct measurement of EF1 and arterial stiffness will be required to assess their relative associations with COVID-19 mortality. Image quality was insufficient to allow measurement of EF1 in a relatively high proportion of cases.…”

Section: Discussionmentioning

confidence: 99%

First-Phase Ejection Fraction, a Measure of Preclinical Heart Failure, Is Strongly Associated With Increased Mortality in Patients With COVID-19

Cirillo

Nabeebaccus

et al. 2021

Hypertension

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Presence of heart failure is associated with a poor prognosis in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to examine whether first-phase ejection fraction (EF1), the ejection fraction measured in early systole up to the time of peak aortic velocity, a sensitive measure of preclinical heart failure, is associated with survival in patients hospitalized with COVID-19. A retrospective outcome study was performed in patients hospitalized with COVID-19 who underwent echocardiography (n=380) at the West Branch of the Union Hospital, Wuhan, China and in patients admitted to King’s Health Partners in South London, United Kingdom. Association of EF1 with survival was performed using Cox proportional hazards regression. EF1 was compared in patients with COVID-19 and in historical controls with similar comorbidities (n=266) who had undergone echocardiography before the COVID-19 pandemic. In patients with COVID-19, EF1 was a strong predictor of survival in each patient group (Wuhan and London). In the combined group, EF1 was a stronger predictor of survival than other clinical, laboratory, and echocardiographic characteristics including age, comorbidities, and biochemical markers. A cutoff value of 25% for EF1 gave a hazard ratio of 5.23 ([95% CI, 2.85–9.60]; P <0.001) unadjusted and 4.83 ([95% CI, 2.35–9.95], P <0.001) when adjusted for demographics, comorbidities, hs-cTnI (high-sensitive cardiac troponin), and CRP (C-reactive protein). EF1 was similar in patients with and without COVID-19 (23.2±7.3 versus 22.0±7.6%, P =0.092, adjusted for prevalence of risk factors and comorbidities). Impaired EF1 is strongly associated with mortality in COVID-19 and probably reflects preexisting, preclinical heart failure.

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Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Cited by 48 publications

References 40 publications

Carotid stiffness, intima–media thickness and aortic augmentation index among adults with SARS‐CoV‐2

Carotid stiffness, intima–media thickness and aortic augmentation index among adults with SARS‐CoV‐2

Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry

First-Phase Ejection Fraction, a Measure of Preclinical Heart Failure, Is Strongly Associated With Increased Mortality in Patients With COVID-19

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