Vascular alterations among young adults with SARS-CoV-2

Ratchford, Stephen M.; Stickford, Jonathon L.; Province, Valesha M.; Stute, Nina L.; Augenreich, Marc; Koontz, Laurel K.; Bobo, Landry; Stickford, Abigail S.L.

doi:10.1152/ajpheart.00897.2020

Cited by 143 publications

(228 citation statements)

References 31 publications

Supporting

Mentioning

201

Contrasting

Unclassified

Order By: Relevance

“…In the current case study, multiple assessments of vascular endothelial function, including FMD, reactive hyperemia, and PLM-induced hyperemia were lower at V2 , when the young woman was predominantly presymptomatic. Recent work by Ratchford et al ( 38 ) reported similar and marked reductions in FMD and PLM in young healthy men and women 3–4 wk after mild-to-moderate infection. Together, these findings suggest that vascular dysfunction is likely an early pathophysiological response to COVID-19, evident across macrovascular and microvascular compartments, and a critical component of COVID-19 sequelae that persists for weeks after infection.…”

Section: Discussionmentioning

confidence: 78%

“…Circulating markers of endothelial function and endotheliopathy were not assessed in this case study, which limits direct comparison with recent studies reporting elevated markers of endothelial injury and endotheliopathy in patients with critical COVID-19 infection ( 69 , 70 ). Further investigation examining endothelial responses to COVID-19 are certainly warranted, as current data indicates that functional measures of vascular endothelial dysfunction (FMD, hyperemia, and PLM) are impaired in mild cases of COVID-19 ( 38 ), whereas elevated markers of endothelial injury and endotheliopathy may be reserved for critical cases of COVID-19 ( 69 , 70 ). Lastly, due to significant fatigue and intermittent bouts of vigorous coughing, the participant opted out of additional laboratory-based follow up, which precluded the collection of additional, potentially very insightful data regarding COVID-19 and PASC.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of presymptomatic COVID-19 on vascular and skeletal muscle function: a case study

Trinity

Craig

Fermoyle

et al. 2021

Journal of Applied Physiology

View full text Add to dashboard Cite

The impact of COVID-19 has been largely described after symptom development. Although the SARS-CoV-2 virus elevates heart rate (HR) prior to symptom onset, whether this virus evokes other presymptomatic alterations is unknown. This Case Study details the presymptomatic impact of COVID-19 on vascular and skeletal muscle function in a young woman (24yrs, 173.5cm, 89kg, BMI: 29.6kg·m-2). Vascular and skeletal muscle function were assessed as part of a separate study with the first and second visits separated by 2 weeks. On the evening following the second visit, the participant developed a fever and a rapid antigen test confirmed a positive COVID-19 diagnosis. Compared to the first visit, the participant presented with a markedly elevated HR (~ 30 bpm) and lower mean blood pressure (~8 mmHg) at the second visit. Vascular function measured by brachial artery flow-mediated dilation, reactive hyperemia, and passive leg movement were all noticeably attenuated (25-65%) as was leg blood flow during knee extension exercise. Muscle strength was diminished as was ADP stimulated respiration (30%), assessed in vitro, while there was a 25% increase in the apparent Km. Lastly, an elevation in IL-10 was observed prior to symptom onset. Notably, 2.5 months after diagnosis symptoms of fatigue and cough were still present. Together, these findings provide unique insight into the physiological responses immediately prior to COVID-19 symptom onset; they suggest that SARS-CoV-2 negatively impacts vascular and skeletal muscle function prior to the onset of common symptoms and may set the stage for the widespread sequelae observed following COVID-19 diagnosis.

show abstract

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Impact of presymptomatic COVID-19 on vascular and skeletal muscle function: a case study

Trinity

Craig

Fermoyle

et al. 2021

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

“…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).…”

Section: New Findingsmentioning

confidence: 96%

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

Szeghy

Province

Stute

et al. 2021

Experimental Physiology

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Based on data of a recent study on a similar patient population [41], a sample of 63 patients was considered necessary to detect an expected pre-defined increase in FMD from baseline values of ≥40% with a power of 80% and a level of significance of 5%. To account for possible drop-outs or technical failures during FMD measurements, we planned to screen ≈100 patients for eligibility.…”

Section: Sample Sizementioning

confidence: 99%

Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation

et al. 2021

View full text Add to dashboard Cite

Background: Growing evidence points to a key role of endothelial dysfunction in the pathogenesis of COVID-19. In this study, we evaluated changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of convalescent COVID-19 patients undergoing pulmonary rehabilitation (PR). Methods: After swab test negativization, convalescent COVID-19 patients referring to a post-acute care facility for PR were consecutively screened for inclusion. Study procedures were performed at the time of hospitalization and discharge. Results: We enrolled 82 convalescent COVID-19 patients (85.4% males, mean age 60.4 years). After PR, a significant improvement in most pulmonary function tests and exercise capacity was documented. FMD changed from 2.48% ± 2.01 to 4.24% ± 2.81 (p < 0.001), corresponding to a 70.9% increase. Significantly higher changes in FMD were found in patients without a history of vascular events as compared to those with (+2.04% ± 2.30 vs. +0.61% ± 1.83, p = 0.013). Values of forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC%) and diffusion capacity for carbon monoxide (DLCO%) significantly and directly correlated with FMD both at baseline and after PR. Patients with normal FEV1% (≥80% predicted) during the overall study period or those normalizing FEV1% after PR showed a more significant FMD change as compared to patients with persistently impaired FEV1% (<80% predicted) (p for trend = 0.029). This finding was confirmed in a multivariate analysis. Conclusions: Clinically evaluated endothelial function improves after PR in convalescent COVID-19 patients. A direct and persistent association between the severity of pulmonary and vascular disease can be hypothesized. Endothelial function testing may be useful in the follow-up of convalescent COVID-19 patients.

show abstract

Vascular alterations among young adults with SARS-CoV-2

Cited by 143 publications

References 31 publications

Impact of presymptomatic COVID-19 on vascular and skeletal muscle function: a case study

Impact of presymptomatic COVID-19 on vascular and skeletal muscle function: a case study

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

Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation

Contact Info

Product

Resources

About